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
ALJ Beth Whitaker
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. BCS 207050 (Wis. Div. of Hearings and Appeals February 8, 2023) (DHS) ↓ Download PDF A Medicaid appeal must be filed within 45 days of a negative action. In this case, the petitioner’s mother contacted the agency in May 2020 to report getting a job and ask for her BadgerCare Plus benefits […] 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
DHA Case No. BCS 204450 (Wis. Div. of Hearings and Appeals March 29, 2022) (DHS) ↓ Download PDF In general, all taxable gross income is counted when determining eligibility for BadgerCare Plus, including Social Security income. In this case, the petitioner deposited his Social Security into an ABLE account. ALJ Beth Whitaker found that the […] 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. MAC 205887 (Wis. Div. of Hearings and Appeals December 29, 2022) (DHS) ↓ Download PDF A mailed hearing request is considered filed on the date of the postmark or the date DHA actually receives it, whichever is earlier. In this case, the petitioner mailed the request, but there was no postmark and […] Read more