ALJ Brian C. Schneider

DHA Case No. MPA 207077 (Wis. Div. of Hearings and Appeals January 27, 2023) (DHS) ↓ Download PDF Personal care services under Medicaid must be medically necessary and cost-effective. In this case, the petitioner asked for 19.5 Personal Care Worker (PCW) hours per week but was only approved for 10.25. ALJ Brian Schneider upheld the […] Read more

DHA Case No. FCP 208209 (Wis. Div. of Hearings and Appeals May 31, 2023) (DHS) ↓ Download PDF In the Family Care program, the MCO must develop an Individual Service Plan with the client that addresses the client’s needs while being cost-effective. The MCO does not have to provide a service if there are less […] Read more

DHA Case No. FCP 207518 (Wis. Div. of Hearings and Appeals April 19, 2023) (DHS) ↓ Download PDF Assisted living is a possible residential choice in the Family Care program, but it generally must be cost-effective in addressing the member’s individual service plan. In this case, the petitioner—a 61-year-old woman with autism, anxiety, PTSD, vertigo, […] Read more

DHA Case No. CWA 207408 (Wis. Div. of Hearings and Appeals April 17, 2023) (DHS) ↓ Download PDF To cover a service dog, IRIS policy requires that it be “individually trained by a reputable provider experienced in providing structured training for service dogs to do work or perform tasks for the participant that are directly […] Read more

DHA Case No. CWA 207563 (Wis. Div. of Hearings and Appeals April 3, 2023) (DHS) ↓ Download PDF An IRIS participant may request a budget amendment to pay for an ongoing need not met within the current budget. In this case, the petitioner asked for a budget increase when her home health agency ended her […] Read more

DHA Case No. BCS 207290 (Wis. Div. of Hearings and Appeals February 10, 2023) (DHS) ↓ Download PDF An applicant must be a U.S. citizen or qualifying lawful immigrant to be eligible for Medicaid. In this case, the petitioner applied for MA and was initially approved, but Homeland Security soon notified the agency that the […] Read more

DHA Case No. MDV 207202 (Wis. Div. of Hearings and Appeals February 23, 2023) (DHS) ↓ Download PDF A transfer for less than fair market value is a divestment, and payments to relatives often also need a notarized contract or lease. In this case, the petitioner’s son and POA used the proceeds from selling her […] Read more

DHA Case No. CWA 207110 (Wis. Div. of Hearings and Appeals March 29, 2023) (DHS) ↓ Download PDF The IRIS program can pay for equine therapy, according to the participant’s needs. In this case, the petitioner was approved for three months of twice-weekly equine therapy, which proved effective, but her subsequent request to continue the […] Read more

DHA Case No. CWK 206852 (Wis. Div. of Hearings and Appeals January 10, 2023) (DHS) ↓ Download PDF Vehicle modifications are allowed as a benefit of the Children’s Long-Term Support program, but they must “meet all applicable standards of manufacture, safety, design, and installation.” In this case, the petitioner’s mother asked for a modification to […] Read more

DHA Case No. MKB 200264 (Wis. Div. of Hearings and Appeals January 11, 2021) (DHS)  ↓ Download PDF The final step in the disability determination process for the Katie Beckett program is determining if the child has “marked limitations” in two of six domains or an “extreme limitation” in one. In this case, the DDB […] Read more

DHA Case No. MGE 196806 (Wis. Div. of Hearings and Appeals January 9, 2020) (DHS) ↓ Download PDF An applicant must be under the asset limit as of the last day of the month for that month’s eligibility. In this case, the petitioner’s eligibility for August was denied because her bank statement showed a high […] Read more

DHA Case No. MGE 197380 (Wis. Div. of Hearings and Appeals March 2, 2020) (DHS) ↓ Download PDF In general, a Medicaid application must be processed within 30 days (plus 10 days if needed to provide verification) and the applicant has the burden of providing the needed verification. This case, however, was “highly unusual” for […] Read more

DHA Case No. MGE 199939 (Wis. Div. of Hearings and Appeals April 19, 2021) (DHS) ↓ Download PDF Non-homestead real estate is countable unless it is listed for sale with a realtor. In this unusual case, the petitioner owned some land with a mobile home, but realtors refused to list it because of its condition […] Read more

DHA Case No. 204650 (Wis. Div. of Hearings and Appeals May 3, 2022) (DHS) ↓ Download PDF A resident alien is generally not eligible for public assistance benefits for five years after his or her date of entry. In this case, the petitioner had entered the country less than five years before applying for SeniorCare […] Read more