DHA Case No. CWA 216468 (Wis. Div. Hearings and Appeals Aug. 4, 2025) (DHS) ↓ Download PDF Late renewals can cause a gap in Community Waivers enrollment, though the Department has allowed for an expedited re-enrollment process to minimize this. In this case, the petitioner completed a late renewal and would have used the expedited […] Read more

DHA Case No. MDV 216455 (Wis. Div. Hearings and Appeals June 6, 2025) (DHS) ↓ Download PDF An undue hardship waiver of a divestment penalty may be approved if the divested assets are not recoverable and the member would otherwise be deprived of necessary medical care, shelter, or other necessities. In this case, the petitioner’s […] Read more

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 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 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. CWK 211705 (Wis. Div. Hearings and Appeals Sep. 10, 2024) (DHS) ↓ Download PDF Individual choice of provider is a main tenet of the CLTS program. Even when a county has concerns about a provider, the County Waiver Agency must respect the participant’s choice “unless there is compelling justification not to do […] Read more

DHA Case No. FCP 216075 (Wis. Div. Hearings and Appeals Feb. 24, 2025) (DHS) ↓ Download PDF When an MCO seeks to reduce services, it has the burden of proof and must justify its action. In this case, an Inclusa representative justified its reduction of Supportive Home Care (SHC) hours from 496 to 446 per […] Read more

DHA Case No. MDV 215995 (Wis. Div. Hearings and Appeals Feb. 7, 2025) (DHS) ↓ Download PDF Selling real estate for less than its fair market value is generally a divestment. In this case, the petitioner sold a real estate parcel to her son for $25,531.69; its estimated fair market value on the tax assessment […] Read more

DHA Case No. CWA 215956 (Wis. Div. Hearings and Appeals Feb. 28, 2025) (DHS) ↓ Download PDF To be approved as part of an IRIS budget, services must generally be cost-effective. In this case, the petitioner requested a budget amendment to pay $30 and $35 per hour for Supportive Home Care (SHC) services. The agency […] Read more

DHA Case No. CWA 212682 (Wis. Div. Hearings and Appeals Jul. 12, 2024) (DHS) ↓ Download PDF Customized goods or services under the IRIS program must generally be necessary and cost-effective. In this case, the petitioner already had one trained service dog (the training was approved in a prior appeal) but wanted IRIS to pay […] Read more

DHA Case No. MDV 211510 (Wis. Div. of Hearings and Appeals April 5, 2024) (DHS) ↓ Download PDF DHA Case No. MGE 211214 (Wis. Div. of Hearings and Appeals April 5, 2024) (DHS) ↓ Download PDF Generally, the transfer of a life estate without receiving fair market value in return is a divestment. In this […] Read more

DHA Case No. CWA 212780 (Wis. Div. of Hearings and Appeals June 10, 2024) (DHS) ↓ Download PDF When the Department reduces benefits, it has the burden of proof and must at least present a prima facie case for its decision. In this case, the agency reduced services it had previously deemed necessary and appropriate […] Read more

DHA Case No. FCP 211909 (Wis. Div. of Hearings and Appeals April 23, 2024) (DHS) ↓ Download PDF An individual is functionally eligible for Family Care if he or she needs a “nursing home” level of care, as determined by the functional screen. In this case, the petitioner’s functional screen found the petitioner functionally ineligible […] Read more