DHA Case No. CWA 219952 (Wis. Div. Hearings and Appeals Dec. 10, 2025) (DHS) ↓ Download PDF The Department may deny enrollment in the IRIS program for substantiated fraud during a previous enrollment, living in an ineligible residential setting, or inability or unwillingness to develop an Individual Support and Service Plan (ISSP) that ensures the […] Read more

DHA Case No. CWK 220287 (Wis. Div. Hearings and Appeals Dec. 16, 2025) (DHS) ↓ Download PDF To be covered by the CLTS program, a service dog must (a) do work or perform tasks for the benefit of a person with a disability, who (b) has a disability that substantially limits his/her ability to perform […] Read more

DHA Case No. MDV 220070 (Wis. Div. Hearings and Appeals Dec. 10, 2025) (DHS) ↓ Download PDF The action of avoiding the receipt of income that a Medicaid member is entitled to is a divestment. In this case, the petitioner revocably renounced a VA survivor’s pension, which was $948 normal pension and $567 Aid and […] Read more

DHA Case No. CWA 220073 (Wis. Div. Hearings and Appeals Dec. 5, 2025) (DHS) ↓ Download PDF When the IRIS program ends a participant’s enrollment involuntarily, it bears the burden of proof to show that the disenrollment was proper. In this case, the IRIS Consultant (IC) submitted only an unsigned, unsworn written statement about an […] Read more

DHA Case No. FCP 219522 (Wis. Div. Hearings and Appeals Oct. 28, 2025) (DHS) ↓ Download PDF When an MCO reduces a service, it has the burden to prove that the reduction is appropriate. In this case, Inclusa sought to end a lawn care service because it expected the petitioner’s wife to do the yard […] Read more

DHA Case No. CWA 219173 (Wis. Div. Hearings and Appeals Oct. 1, 2025) (DHS) ↓ Download PDF When a person’s eligibility for SSI ends, agency policy is to automatically run Medicaid eligibility under other criteria. In this case, the petitioner’s SSI ended and she even received a notice saying she didn’t need to do anything […] Read more

DHA Case No. MGE 219014 (Wis. Div. Hearings and Appeals Oct. 6, 2025) (DHS) ↓ Download PDF IRIS enrollment dates may be revised if the agency is the cause of a wrongful termination of IRIS enrollment. In this case, the agency sent advance notice of the renewal deadline and a notice requiring verification of a […] Read more

DHA Case No. CWA 219176 (Wis. Div. Hearings and Appeals Oct. 1, 2025) (DHS) ↓ Download PDF IRIS enrollment dates may be revised if the agency is the cause of a wrongful termination of IRIS enrollment. In this case, the agency called the petitioner before her renewal deadline but she declined to do the renewal […] Read more

DHA Case No. MGE 218210 (Wis. Div. Hearings and Appeals Aug. 6, 2025) (DHS) ↓ Download PDF Financial eligibility for Medicaid generally requires a single individual’s countable, available assets to be less than $2,000. In this case, the petitioner submitted a bank statement in her sole name with a balance of more than $69,000, but […] Read more

DHA Case No. MLL 216729 (Wis. Div. Hearings and Appeals Apr. 21, 2025) (DHS) ↓ Download PDF When estate recovery makes a claim, Wisconsin law gives a right to appeal the issues of the value of the property and the extent of the decedent’s interest in it. In this case, the petitioner disputed the Department’s […] Read more

DHA Case No. FCP 216652 (Wis. Div. Hearings and Appeals Apr. 14, 2025) (DHS) ↓ Download PDF Aservice that is “duplicative with respect to other services being provided” is not medically necessary. In this case, the petitioner lived in an Adult Family Home (AFH) and attended adult day services at a community provider. The MCO […] Read more

DHA Case No. FCP 216051 (Wis. Div. Hearings and Appeals Mar. 28, 2025) (DHS) ↓ Download PDF Whether Family Care must cover placement in an Adult Family Home (AFH) or other group home setting depends on the general criteria of medical necessity and cost-effectivness, among others. In this case, the petitioner lived in an apartment […] Read more

DHA Case No. CWA 216153 (Wis. Div. Hearings and Appeals Mar. 26, 2025) (DHS) ↓ Download PDF When a petitioner is disenrolled due to agency error, ALJs often correct the error by ordering continued enrollment. In this case, the petitioner made numerous attempts to timely complete a renewal but was unable to due to agency […] Read more

DHA Case No. COP 216759 (Wis. Div. Hearings and Appeals Mar. 20, 2025) (DHS) ↓ Download PDF A denial of eligibility or a reduction in services for the Children’s Community Options Program is appealable to DHA, “except that lack of adequate funding may not serve as the basis.” In this case, the petitioner’s county denied […] Read more