ALJ Jason M. Grace

DHA Case No. FCP 209869 (Wis. Div. of Hearings and Appeals January 12, 2024) (DHS) ↓ Download PDF In general, the ADRC has 30 days from the date of request to determine functional eligibility or provide notice of a delay; IM has 30 days from the date of application to determine financial eligibility. In this […] Read more

DHA Case No. FCP 209037 (Wis. Div. of Hearings and Appeals November 14, 2023) (DHS) ↓ Download PDF The Department may backdate Family Care enrollment when there is an agency error that causes an unreasonable delay. In this case, the petitioner was found eligible in December of 2022 and the MCO received her enrollment form […] Read more

DHA Case No. FCP 209188 (Wis. Div. of Hearings and Appeals September 5, 2023) (DHS) ↓ Download PDF An appeal of a negative MA decision must be filed, at most, within 90 days (for most decisions it’s 45 days). In this case, the petitioner’s cost share was increased by notices effective September 1, 2022 and […] Read more

DHA Case No. SSO 209011 (Wis. Div. of Hearings and Appeals September 18, 2023) (DHS) ↓ Download PDF DHS cannot recover state SSI benefits that were incorrectly paid more than 12 months before the “date of discovery” of the overpayment. In this case, the Social Security Administration retroactively terminated the petitioner’s SSI eligibility for January […] Read more

DHA Case No. CWA 208939 (Wis. Div. of Hearings and Appeals August 21, 2023) (DHS) ↓ Download PDF When a person must use adaptive aids to perform an activity of daily living (ADL), this counts as needing assistance with the ADL for functional eligibility. In this case, the petitioner was disenrolled from IRIS after a […] Read more

DHA Case No. MQB 209568 (Wis. Div. of Hearings and Appeals October 2, 2023) (DHS) ↓ Download PDF With the Public Health Emergency unwinding, members may voluntarily complete an early renewal, but Income Maintenance agencies must inform members that their eligibility may be impacted by doing an early renewal. In this case, the member’s renewal […] Read more

DHA Case No. CWA 208405 (Wis. Div. of Hearings and Appeals October 16, 2023) (DHS) ↓ Download PDF Community transportation can be covered by IRIS, but the service assumes that someone besides the participant is doing the driving. In this case, the petitioner had a community transportation budget with his wife as the “participant-hired worker” […] Read more

DHA Case No. MDV 208396 (Wis. Div. of Hearings and Appeals June 29, 2023) (DHS) ↓ Download PDF Any transfer of resources for less than fair market value is generally a divestment, but there is an exception if the resource was transferred “exclusively for some other purpose than to become eligible for MA.” In this […] Read more

DHA Case No. MKB 200031 (Wis. Div. of Hearings and Appeals January 14, 2021) (DHS) ↓ Download PDF Mosaic Down Syndrome and non-mosaic Down Syndrome are treated differently under the Social Security disability rules. The latter is listed as a severe impairment and automatically meets the requirements; the former is not. So for mosaic Down […] Read more

DHA Case No. MTI 207782 (Wis. Div. of Hearings and Appeals April 12, 2023) (DHS) ↓ Download PDF A party has 30 days from the date of a tax intercept notice to file an appeal; the filing date is the postmark date or the date of actual receipt by DHA, whichever is earlier. In this […] Read more

DHA Case No. CWA 206353 (Wis. Div. of Hearings and Appeals January 17, 2023) (DHS) ↓ Download PDF Services included in an IRIS member’s budget must be cost effective and at the usual and customary rate for the area. In this case, the petitioner’s medical transportation provider increased its rate for transporting him to his […] Read more

DHA Case No. MGE 207580 (Wis. Div. of Hearings and Appeals April 14, 2023) (DHS) ↓ Download PDF An institutionalized spouse may allocate income to the community spouse up to a certain amount, and an ALJ may increase that if the petitioner shows “exceptional circumstances resulting in financial duress.” In this case, the petitioner appealed […] Read more

DHA Case No. BCS 207530 (Wis. Div. of Hearings and Appeals April 6, 2023) (DHS) ↓ Download PDF Wisconsin law provides that able-bodied adults who refused to cooperate in establishing the paternity of a child without good cause are ineligible for MA. In this case, the petitioner refused to identify the father of her child […] Read more

DHA Case No. CWA 207474 (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 from $15.75 to $17/hr to pay for […] Read more