DHA Case No. MAP 212141 (Wis. Div. of Hearings and Appeals March 27, 2024) (DHS) ↓ Download PDF An asset is considered unavailable if the owner documents that it will not be available for 30 days or more and a process has been started to obtain the assets. In this case, the petitioner could access […] Read more

DHA Case No. FCP 211586 (Wis. Div. of Hearings and Appeals March 26, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the ADRC told the petitioner not to apply for MA until after the functional screen was completed, […] Read more

DHA Case No. MGE 211383 (Wis. Div. of Hearings and Appeals March 28, 2024) (DHS) ↓ Download PDF The patient liability for an institutionalized person generally leaves only a small amount of money for personal needs ($45 at the time of this case, now $55). In this case, the petitioner complained that her $45 per […] Read more

DHA Case No. FCP 211142 (Wis. Div. of Hearings and Appeals March 19, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the petitioner filed an application October 10, but the agency never told his authorized representative of the […] Read more

DHA Case No. CWK 211595 (Wis. Div. of Hearings and Appeals March 22, 2024) (DHS) ↓ Download PDF The legal standards of functional eligibility for the Children’s Long-Term Support (CLTS) Waiver program and for the Katie Beckett program are identical. In this odd case, the petitioner was determined functionally ineligible for her CLTS renewal by […] Read more

DHA Case No. MGE 211311 (Wis. Div. of Hearings and Appeals March 19, 2024) (DHS) ↓ Download PDF Tribal General Welfare Assistance (GWA) is exempt income only if it is based on the individual’s demonstration of need. In this case, the petitioner received GWA that was apparently not based on need. ALJ Teresa Perez concluded […] Read more

DHA Case No. FCP 211940 (Wis. Div. of Hearings and Appeals March 19, 2024) (DHS) ↓ Download PDF In general, all Family Care services must be authorized before they are provided. In this case, the petitioner’s assisted living facility closed and he had to move to a new one. My Choice staff met with him […] Read more

DHA Case No. MGE 211566 (Wis. Div. of Hearings and Appeals March 15, 2024) (DHS) ↓ Download PDF Countable assets do not include income received that month and money that is not available. In this case, the petitioner’s eligibility for July was denied because the agency counted $1,599 in Social Security (deposited July 3) and […] Read more

DHA Case No. CWK 210726 (Wis. Div. of Hearings and Appeals March 15, 2024) (DHS) ↓ Download PDF Individual choice of provider is a main tenet of the CLTS program. Even when a background check on a proposed provider reveals negative—but not disqualifying—findings, the County Waiver Agency must respect the participant’s choice “unless there is […] Read more

DHA Case No. CWA 211353 (Wis. Div. of Hearings and Appeals March 14, 2024) (DHS) ↓ Download PDF DHS automatically disenrolls an IRIS participant when he or she loses basic Medicaid eligibility. In this case, the petitioner failed to get his renewal verification in on time and was disenrolled from Medicaid and IRIS. Although he […] Read more

DHA Case No. MDV 210958 (Wis. Div. of Hearings and Appeals March 13, 2024) (DHS) ↓ Download PDF The fair market value of real estate may be established by assessment, statements from realtors, or a comparative market analysis. In this case, the agency relied solely on the fair market value estimate it found on Zillow […] Read more

DHA Case No. MNP 211393 (Wis. Div. of Hearings and Appeals March 8, 2024) (DHS) ↓ Download PDF Wisconsin Medicaid covers emergency out-of-state services, even if the provider is not certified with Wisconsin Medicaid. In this case, the petitioner had a seizure while in Florida with her family and was transported by ambulance. The ambulance […] Read more

DHA Case No. MAP 211494 (Wis. Div. of Hearings and Appeals March 6, 2024) (DHS) ↓ Download PDF To be exempt homestead property, the property must serve as the individual’s primary place of residence. In this case, the petitioner owned real estate worth $25,000 and claimed he lived there in a tent, providing documents and […] Read more

DHA Case No. CWA 211775 (Wis. Div. of Hearings and Appeals March 5, 2024) (DHS) ↓ Download PDF To be functionally eligible for IRIS, a person must be unable to safely or appropriately perform some combination of activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The Department’s instructions for completing the […] Read more