DHA Case No. FCP 217860 (Wis. Div. Hearings and Appeals May 28, 2025) (DHS) ↓ Download PDF DHA decisions have recognized for nearly a decade that use of an adaptive aid is equivalent to requiring human assistance and counts as requiring assistance with the related ADL. In this case, the petitioner’s functional screen noted a […] Read more

DHA Case No. CWA 216813 (Wis. Div. Hearings and Appeals May 9, 2025) (DHS) ↓ Download PDF The IRIS waiver requires IRIS Consultant Agencies (ICAs) to monitor participants’ health and safety, address health and safety concerns with the participant, and ultimately disenroll participants when health and safety concerns remain despite remediation efforts. In this case, […] Read more

DHA Case No. CWA 217415 (Wis. Div. Hearings and Appeals May 5, 2025) (DHS) ↓ Download PDF The Department may disenroll IRIS participants if it cannot develop a plan that ensures the participant’s health and safety. In this case, the petitioner’s behavior support plan—staff call 911 and seek refuge in their cars if he gets […] Read more

DHA Case No. MGE 216015 (Wis. Div. Hearings and Appeals Apr. 11, 2025) (DHS) ↓ Download PDF Family Care benefits cannot begin until the applicant is enrolled in an MCO following an approved application. In this case, the petitioner applied and was approved, but died before actually enrolling in an MCO, about 30 days after […] Read more

DHA Case No. MGE 216305 (Wis. Div. Hearings and Appeals Mar. 24, 2025) (DHS) ↓ Download PDF Income received in a month is not counted as an asset unless and until it is retained into the following month. In this case, the petitioner applied in September and requested backdating to June and July. She submitted […] Read more

DHA Case No. MGE 216363 (Wis. Div. Hearings and Appeals Feb. 28, 2025) (DHS) ↓ Download PDF A Medicaid applicant must be below the asset limit on the last day of the month to be eligible that month. In this case, the petitioner’s application was denied due to the cash value of a life insurance […] Read more

DHA Case No. MGE 216012 (Wis. Div. Hearings and Appeals Feb. 18, 2025) (DHS) ↓ Download PDF A notice is not adequate if it does not expressly identify the program for which benefits are denied. Also, an application cannot be denied merely because the applicant lacks the power to produce verification. In this case, the […] Read more

DHA Case No. MQB 216374 (Wis. Div. Hearings and Appeals Feb. 10, 2025) (DHS) ↓ Download PDF The SLMB+ Medicare savings program has higher income limits but is only available to those not enrolled in a full-benefit Medicaid program, such as MAPP. In this case, the petitioner was initially enrolled in MAPP and therefore not […] Read more

DHA Case No. MGE 215891 (Wis. Div. Hearings and Appeals Feb. 4, 2025) (DHS) ↓ Download PDF An ALJ can increase the Community Spouse Resource Allowance (CSRA) if the additional resources are needed to generate income for the community spouse up to the Minimum Monthly Maintenance Needs Allowance (MMMNA). In this case, the petitioner had […] Read more

DHA Case No. MAP 216062 (Wis. Div. Hearings and Appeals Feb. 4, 2025) (DHS) ↓ Download PDF The agency may not require one particular type of verification when various types are adequate and available. In this case, the petitioner owned a newly incorporated business with no previous tax filings. Instead of submitting a self-employment income […] Read more

DHA Case No. MDV 215927 (Wis. Div. Hearings and Appeals Feb. 3, 2025) (DHS) ↓ Download PDF If an irrevocable annuity can be sold on the secondary market, it is a countable, available asset. In this case, the petitioner owned an irrevocable annuity but could still transfer ownership and change the beneficiary and had received […] Read more

DHA Case No. CWA 215899 (Wis. Div. Hearings and Appeals Jan. 30, 2025) (DHS) ↓ Download PDF An appeal of an adverse benefit determination by an MCO must generally be filed within 90 days. Additionally, issues that have been decided in a previous appeal are precluded. In this case, the petitioner faxed her appeal of […] Read more

DHA Case No. FCP 215537 (Wis. Div. Hearings and Appeals Jan. 24, 2025) (DHS) ↓ Download PDF Family Care services must generally be from appropriate and qualified providers, be fair and safe, serve to maintain community connections, and be cost effective. In this sympathetic case, the petitioner—a competent 43-year-old man with muscular dystrophy, severe respiratory […] Read more

DHA Case No. CWA 215921 (Wis. Div. Hearings and Appeals Jan. 22, 2025) (DHS) ↓ Download PDF Providers are generally not allowed to restrain MA participants, but this rule can be waived after an application to the Department. In this case, the petitioner had a waiver that expired June 21, 2024. Although his mother reapplied […] Read more