DHA Case No. CWK 216983 (Wis. Div. Hearings and Appeals Apr. 28, 2025) (DHS) ↓ Download PDF For a CLTS participant age 12 or older, covered “child care” can include school and community-based settings such as after school programs and 4-H. In this case, the petitioner requested funding for two three-week camp programs at the […] Read more

DHA Case No. FCP 216785 (Wis. Div. Hearings and Appeals Apr. 14, 2025) (DHS) ↓ Download PDF To be functionally eligible for home and community based long term care services through the PACE program, an individual must require a “nursing home” level of care. In this case, the petitioner required assistance with one ADL and […] Read more

DHA Case No. FCP 216652 (Wis. Div. Hearings and Appeals Apr. 14, 2025) (DHS) ↓ Download PDF Aservice that is “duplicative with respect to other services being provided” is not medically necessary. In this case, the petitioner lived in an Adult Family Home (AFH) and attended adult day services at a community provider. The MCO […] Read more

DHA Case No. FCP 217068 (Wis. Div. Hearings and Appeals Apr. 7, 2025) (DHS) ↓ Download PDF Aservice that is “duplicative with respect to other services being provided” is not medically necessary. In this case, the petitioner attended adult day services with a certain provider while living with her siblings for several years. But when […] Read more

DHA Case No. BCS 216832 (Wis. Div. Hearings and Appeals Apr. 7, 2025) (DHS) ↓ Download PDF The agency must mail a notice of adverse action at least 10 days prior to the effective date. In this case, the petitioner never received a notice that her BadgerCare Plus renewal was due, but the agency did […] Read more

DHA Case No. FCP 216051 (Wis. Div. Hearings and Appeals Mar. 28, 2025) (DHS) ↓ Download PDF Whether Family Care must cover placement in an Adult Family Home (AFH) or other group home setting depends on the general criteria of medical necessity and cost-effectivness, among others. In this case, the petitioner lived in an apartment […] Read more

DHA Case No. WFC 215794 (Wis. Div. Hearings and Appeals Mar. 27, 2025) (DHS) ↓ Download PDF The Wisconsin Funeral and Cemetery Aids Program (WFCAP) pays up to $1,500 of the funeral and burial expenses and up to $1,000 of the cemetery expenses of certain indigent recipients of public benefits. However, the program does not […] Read more

DHA Case No. FCP 216227 (Wis. Div. Hearings and Appeals Mar. 27, 2025) (DHS) ↓ Download PDF A participant in Family Care cannot be disenrolled without proper advance notice. In this case, the petitioner apparently missed a yearly renewal due in August and had difficulty navigating the re-enrollment process with the ADRC (“sometime in December […] Read more

DHA Case No. CWA 216153 (Wis. Div. Hearings and Appeals Mar. 26, 2025) (DHS) ↓ Download PDF When a petitioner is disenrolled due to agency error, ALJs often correct the error by ordering continued enrollment. In this case, the petitioner made numerous attempts to timely complete a renewal but was unable to due to agency […] Read more

DHA Case No. COP 216759 (Wis. Div. Hearings and Appeals Mar. 20, 2025) (DHS) ↓ Download PDF A denial of eligibility or a reduction in services for the Children’s Community Options Program is appealable to DHA, “except that lack of adequate funding may not serve as the basis.” In this case, the petitioner’s county denied […] Read more

DHA Case No. CWA 216762 (Wis. Div. Hearings and Appeals Mar. 19, 2025) (DHS) ↓ Download PDF Around 2017 DHS instituted a policy that a caregiver should not be approved for more than 40 hours per week of paid services, including SHC covered by IRIS and other forms of caregiving such as personal care worker […] Read more

DHA Case No. CWA 216860 (Wis. Div. Hearings and Appeals Mar. 18, 2025) (DHS) ↓ Download PDF IRIS participants must pay their providers a “usual and customary rate.” In this case, the petitioner sought an increase in the daily rate of his adult day services provider from $157.50 to $168.50. Noting the difference between the customary […] Read more

DHA Case No. BCS 216544 (Wis. Div. Hearings and Appeals Mar. 14, 2025) (DHS) ↓ Download PDF Certain payments to live-in care providers under the Family Care and IRIS programs do not counts as income for BadgerCare Plus eligibility. In this case, the petitioner argued his $2,797 monthly income should not be counted under these […] Read more

DHA Case No. CWK 216266 (Wis. Div. Hearings and Appeals Mar. 12, 2025) (DHS) ↓ Download PDF Achild in the Children’s Long-Term Support (CLTS) program must be recertified annually, including an updated functional screen. In this case, the petitioner was found functionally ineligible at her recertification, based on the criteria for the psychiatric hospital level […] Read more