DHA Case No. MOP 204371 (Wis. Div. of Hearings and Appeals May 2, 2022) (DHS) ↓ Download PDF A person must be a resident of Wisconsin to receive Medicaid benefits, and residency ends if another state determines the person to be a resident for its own Medicaid programs. In this case, the petitioner applied for […] Read more

DHA Case No. 204650 (Wis. Div. of Hearings and Appeals May 3, 2022) (DHS) ↓ Download PDF A resident alien is generally not eligible for public assistance benefits for five years after his or her date of entry. In this case, the petitioner had entered the country less than five years before applying for SeniorCare […] Read more

DHA Case No. MRA 205971 (Wis. Div. of Hearings and Appeals October 17, 2022) (DHS) ↓ Download PDF An ALJ may increase the Community Spouse Income Allowance (CSIA) if either spouse proves exceptional circumstances resulting in financial duress. In this case, although the community spouse had $3,858.22 of her own income, she also had monthly […] Read more

DHA Case No. FCP 206406 (Wis. Div. of Hearings and Appeals November 22, 2022) (DHS) ↓ Download PDF The Family Care Contract prohibits an MCO from denying services that are “reasonable and necessary to cost-effectively support the member’s long term care outcomes …”. In this case, the petitioner asked for a home modification: stairs to […] Read more

DHA Case No. FCP 206000 (Wis. Div. of Hearings and Appeals October 28, 2022) (DHS) ↓ Download PDF To be functionally eligible for Family Care, a person must fall into one of the program’s target groups in addition to needing a nursing home level of care. In this case, the petitioner was 44 and diagnosed […] Read more

DHA Case No. CWA 206149 (Wis. Div. of Hearings and Appeals January 12, 2023) (DHS) ↓ Download PDF The Department must ensure the health and safety of IRIS participants, which it does in part by conducting in-home visits. The IRIS policy manual allows involuntary disenrollment for “health and safety risks that participants are unable or […] Read more

DHA Case No. CWA 206378 (Wis. Div. of Hearings and Appeals December 5, 2022) (DHS) ↓ Download PDF An individual is functionally eligible for Family Care if he or she needs a “nursing home” level of care, as determined by the functional screen. This level of care includes those who cannot safely or appropriately perform […] Read more

DHA Case No. MGE 201120 (Wis. Div. of Hearings and Appeals April 29, 2021) (DHS) ↓ Download PDF When a Medicaid applicant is the grantor of a trust—even an irrevocable trust—it is countable and available “if there are any circumstances under which payment from the trust could be made to or for the benefit of […] Read more

DHA Case No. FCP 181279 (Wis. Div. of Hearings and Appeals January 22, 2018) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook allows business property to be exempted—regardless of value or rate of return—if the individual is “actively involved in the business operation on a day-to-day basis.” In this case, the petitioner had a history of renting […] Read more

DHA Case No. MGE 198872 (Wis. Div. of Hearings and Appeals August 12, 2020) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook allows business property to be exempted—regardless of value or rate of return—if the individual is “actively involved in the business operation on a day-to-day basis.” Rental property is not exempt unless the owner is in […] Read more

DHA Case No. MGE 208281 (Wis. Div. of Hearings and Appeals May 30, 2023) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook contains two main ways to exempt “property essential to self-support.” The property is (1) exempt (regardless of value or rate of return) if used in a business in which the individual is actively […] Read more

DHA Case No. MRA 178406 (Wis. Div. of Hearings and Appeals January 13, 2017) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook contains two competing rules: revocable annuities are countable and available assets, but IRAs belonging to a community spouse are disregarded. In this case, the community spouse owned an Individual Retirement Annuity, funded by […] Read more

DHA Case No. MPC-13/78330 (Wis. Div. of Hearings and Appeals November 1, 2006) (DHS)  ↓ Download PDF In Community Waivers cases, countable income is first used in eligibility determinations to place an applicant into a group; then the post-eligibility cost share is calculated based on the formula for that group. In this case, the petitioner’s […] Read more

DHA Case No. MDV 206205 (Wis. Div. of Hearings and Appeals December 2, 2022) (DHS)  ↓ Download PDF Issue 1: “Irrevocable assignment” The Medicaid Eligibility Handbook provides that an asset is available when the owner can dispose of it, has a legal right to its value, has the legal ability to make it available, and can make […] Read more