ALJ Beth Whitaker

DHA Case No. MDV 210996 (Wis. Div. of Hearings and Appeals December 27, 2023) (DHS) ↓ Download PDF The penalty period for divestments reported or discovered during the COVID-19 does not begin until “the member’s next renewal that occurs after April 1, 2023.” In this case, the petitioner sold her house in January 2023 and […] Read more

DHA Case No. MGE 209688 (Wis. Div. of Hearings and Appeals October 19, 2023) (DHS) ↓ Download PDF A recipient of IRIS must usually pay a cost share after deducting a basic needs allowance, a special housing amount, health insurance premiums, and certain out-of-pocket medical/remedial expenses. In this case, the petitioner had fairly high income […] Read more

DHA Case No. MGE 209285 (Wis. Div. of Hearings and Appeals September 19, 2023) (DHS) ↓ Download PDF Vehicles used for transportation can be countable assets (apart from one exempt vehicle), but household goods used for maintenance, use, and occupancy of the premises are not countable. In this case, the petitioner’s Medicaid application was denied […] Read more

DHA Case No. MAC 208599 (Wis. Div. of Hearings and Appeals July 19, 2023) (DHS) ↓ Download PDF A Medicaid appeal must be filed with the Division of Hearings and Appeals, not a different agency, by the deadline. In this case, the petitioner apparently mailed his appeal to the county agency (i.e., DHS) rather than […] Read more

DHA Case No. MGE 208326 (Wis. Div. of Hearings and Appeals July 18, 2023) (DHS) ↓ Download PDF Amember’s patient liability can be reduced to allow payment of medical or remedial expenses that the member “has incurred, is actually paying, and is legally obligated to pay.” In this case, after losing fair hearings on the […] Read more

DHA Case No. MDD 208892 (Wis. Div. of Hearings and Appeals August 22, 2023) (DHS) ↓ Download PDF In making a disability determination, the Disability Determination Bureau (DDB) applies a 5-step test. Step 5 considers whether the individual can adjust to types of work the individual has not performed in the past, considering his or […] Read more

DHA Case No. MDV 208757 (Wis. Div. of Hearings and Appeals July 27, 2023) (DHS) ↓ Download PDF To waive the entire divestment penalty, an undue hardship waiver request must be filed within 20 days of the undue hardship notice letter mailed by the agency. If filed later, the earliest effective date is the date […] Read more

DHA Case No. FCP 208218 (Wis. Div. of Hearings and Appeals June 12, 2023) (DHS) ↓ Download PDF Cost share reductions are effective the month of the change report, even if the actual change in income or expense was earlier. In this case, the petitioner enrolled in Family Care with a cost share effective November […] Read more

DHA Case No. FCP 208068 (Wis. Div. of Hearings and Appeals August 9, 2023) (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’s primary diagnosis was schizophrenia […] Read more

DHA Case No. MGE 207353 (Wis. Div. of Hearings and Appeals June 21, 2023) (Decision on Remand) (DHS) ↓ Download PDF Amember’s patient liability can be reduced to allow payment of medical or remedial expenses that the member “has incurred, is actually paying, and is legally obligated to pay.” In this case, the petitioner verified […] Read more

DHA Case No. BCS 207099 (Wis. Div. of Hearings and Appeals February 20, 2023) (DHS) ↓ Download PDF Countable self-employment income is generally reduced by business expenses, but “principal payments on loans for the purchase price of income-producing real estate, capital assets and equipment, and durable goods” are not allowed expenses for BadgerCare Plus and Medicaid. In […] Read more

DHA Case No. CWA 206183 (Wis. Div. of Hearings and Appeals January 17, 2023) (DHS) ↓ Download PDF The moving party generally has the burden of proof; when an IRIS participant requests new services, the participant must prove that the requested services meet approval criteria by a preponderance of the evidence. In this case, the […] Read more

DHA Case No. MGE 207353 (Wis. Div. of Hearings and Appeals March 28, 2023) (DHS) ↓ Download PDF A member’s patient liability can be reduced to allow payment of medical or remedial expenses that the member “has incurred, is actually paying, and is legally obligated to pay.” In this case, the petitioner verified that he […] Read more

DHA Case No. FCP 203537 (Wis. Div. of Hearings and Appeals January 28, 2022) (DHS) ↓ Download PDF Dental implants are listed as a non-covered service under Wis. Admin. Code § DHS 107.07(4)(i). In this case, the petitioner had strong evidence that dental implant-retained dentures were medically necessary and would support her long-term care outcomes. […] Read more