ALJ John P. Tedesco

DHA Case No. CWA 208908 (Wis. Div. of Hearings and Appeals October 27, 2023) (DHS) ↓ Download PDF In this brief case, the petitioner appealed the termination of her IRIS benefits due to losing functional eligibility. Because she did not appear at the hearing, ALJ John Tedesco dismissed the case and the IRIS termination was […] Read more

DHA Case No. MGE 209934 (Wis. Div. of Hearings and Appeals November 13, 2023) (DHS) ↓ Download PDF Collectibles acquired or held because of their value as an investment are countable assets. In this case, the petitioner owned sports memorabilia worth about $35,000 but argued the collection was (1) unavailable due to the time it […] Read more

DHA Case No. FCP 189482 (Wis. Div. of Hearings and Appeals February 27, 2019) (DHS) ↓ Download PDF To be covered under Family Care, a service must be cost-effective. In this case, the MCO denied the petitioner’s request to install an ADA-height elongated toilet in his rented apartment, saying there were less costly alternatives. ALJ […] Read more

DHA Case No. CWA 189840 (Wis. Div. of Hearings and Appeals January 24, 2019) (DHS) ↓ Download PDF IRIS can pay for a participant-hired worker to attend a conference as a “Community Integration Event” if the participant is also attending. In this case, the petitioner’s mother attended a Fragile X conference alone; she apparently was […] Read more

DHA Case No. CWA 189467 (Wis. Div. of Hearings and Appeals January 3, 2019) (DHS) ↓ Download PDF The IRIS program cannot cover nursing services that are already covered by the state Medicaid plan. In this case, the petitioner’s IRIS supportive home care (SHC) hours were reduced from 96 hours per week to 40 hours […] Read more

DHA Case No. CWA 208350 (Wis. Div. of Hearings and Appeals September 19, 2023) (DHS) ↓ Download PDF The IRIS program can cover “individual directed goods and services” that are not covered under another service category and not obtainable from another source. In this case, the petitioner somehow had IRIS paying for food from vendors […] Read more

DHA Case No. FCP 207851 (Wis. Div. of Hearings and Appeals August 31, 2023) (DHS) ↓ Download PDF An MCO must determine whether a requested service is medically necessary and cost-effective. But in this case, the petitioner’s mother and guardian refused to cooperate with the MCO’s attempts to get the information it needed to make […] Read more

DHA Case No. CWA 208804 (Wis. Div. of Hearings and Appeals September 8, 2023) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook counts some income even though it is unavailable—garnishments, for example. In this case, the petitioner had $300 garnished monthly for a tax debt but his patient liability was not reduced to compensate. ALJ John Tedesco […] Read more

DHA Case No. CWA 208193 (Wis. Div. of Hearings and Appeals October 2, 2023) (DHS) ↓ Download PDF When DHS increases a member’s cost share, it has the burden of proof on appeal. In this rather messy case, it was clear that the cost share should have been lower but it was not clear whose […] Read more

DHA Case No. MDD 207614 (Wis. Div. of Hearings and Appeals April 24, 2023) (DHS) ↓ Download PDF To be eligible for the MAPP program, the applicant must meet the SSI definition of disability. This disability determination considers the applicant’s functional capacity to do various kinds of work. In this case, the applicant was 30 […] Read more

DHA Case No. CWK 207268 (Wis. Div. of Hearings and Appeals March 28, 2023) (DHS) ↓ Download PDF The Children’s Long-Term Support (CLTS) Waiver program can pay for needed home modifications, but they must be cost-effective and solely benefit the participant. In this case, the participant’s mother asked for an interior open-concept remodel, a fence, […] Read more

DHA Case No. FCP 206703 (Wis. Div. of Hearings and Appeals February 16, 2023) (DHS) ↓ Download PDF Family Care can provide supportive home care (SHC) hours to cover services that are necessary, reasonable, appropriate, and cost-effective. In this case, the petitioner’s mother sought an increase in SHC hours so she could be paid to […] Read more

DHA Case No. MQB 207494 (Wis. Div. of Hearings and Appeals May 1, 2023) (DHS) ↓ Download PDF For the Qualified Medicare Beneficiary (QMB) program, benefits cannot begin until the month after the application is processed. In this straightforward case, the petitioner applied but did not complete verification until November 14. ALJ John Tedesco concluded […] Read more

DHA Case No. MDD 206834 (Wis. Div. of Hearings and Appeals March 28, 2023) (DHS) ↓ Download PDF To be eligible for MAPP, an applicant must meet the SSI definition of disability. In this case, the petitioner was a 64-year-old woman with a high school diploma; diagnoses including Bipolar Disorder, ADHD, PTSD, torn rotator cuff, […] Read more

DHA Case No. MGE 166562 (Wis. Div. of Hearings and Appeals August 21, 2015) (DHS) ↓ Download PDF In general, an irrevocable trust established by either spouse is a countable, available asset if there are any circumstances under which the applicant could receive money from the trust. But this policy does not apply to a […] Read more