DHA Case No. CWA 217048 (Wis. Div. Hearings and Appeals Jun. 10, 2025) (DHS) ↓ Download PDF IRIS benefits may be backdated if agency error causes unreasonable delay. In this case, the petitioner was disenrolled from IRIS for failing to verify her husband’s income, but provided that verification and completed a Medicaid renewal the following […] Read more

DHA Case No. MLL 216316 (Wis. Div. Hearings and Appeals Mar. 6, 2025) (DHS) ↓ Download PDF Serving as a caretaker child does not justify a hardship waiver of estate recovery. In this case, the petitioner took care of her father and mother for years in their home, but the home was never transferred to […] Read more

DHA Case No. MGE 216363 (Wis. Div. Hearings and Appeals Feb. 28, 2025) (DHS) ↓ Download PDF A Medicaid applicant must be below the asset limit on the last day of the month to be eligible that month. In this case, the petitioner’s application was denied due to the cash value of a life insurance […] Read more

DHA Case No. MGE 215615 (Wis. Div. Hearings and Appeals Jan. 6, 2025) (DHS) ↓ Download PDF To pay a relative for services in amounts exceeding 10% of the maximum Community Spouse Asset Share requires a written, notarized contract at the time the services were provided. In this case, petitioners were a married couple, both […] Read more

DHA Case No. MGE 217838 (Wis. Div. Hearings and Appeals Jul. 15, 2025) (DHS) ↓ Download PDF Court-ordered support payments are deducted from income for an “institutionalized person,” according to the Medicaid Eligibility Handbook (MEH). In this case, the petitioner paid $4,059 per month in court-ordered spousal support, had monthly income of $12,089.20 ($8,045.98 from a […] Read more

DHA Case No. MGE 216329 (Wis. Div. Hearings and Appeals May 9, 2025) (DHS) ↓ Download PDF When an agency error causes a delay in an individual’s enrollment in Family Care, the enrollment date may be adjusted. In this case, the petitioner submitted his 183-page Medicaid application in three faxes on October 29 and received […] Read more

DHA Case No. MAP 214590 (Wis. Div. Hearings and Appeals Jan. 15, 2025) (DHS) ↓ Download PDF The Wisconsin Administrative Code exempts non-homestead property if it produces a reasonable amount of income, but the Medicaid Eligibility Handbook limits this exemption to $6,000. In this case, the petitioner owned a single rental home that produced at […] Read more

DHA Case No. FCP 216208 (Wis. Div. Hearings and Appeals Feb. 21, 2025) (DHS) ↓ Download PDF In the Family Care program, the MCO must develop an Individual Service Plan that reasonably and effectively addresses all of the client’s long-term needs—but it must also be cost effective, and it can exclude a service the client […] Read more

DHA Case No. FCP 215902 (Wis. Div. Hearings and Appeals Feb. 19, 2025) (DHS) ↓ Download PDF An irrevocable burial trust (as opposed to a life insurance-funded burial contract) is exempt up to $4,500; any amount over that is countable. In this case, the petitioner was disenrolled from Family Care due to his $8,800 irrevocable […] Read more

DHA Case No. MGE 215845 (Wis. Div. Hearings and Appeals Feb. 17, 2025) (DHS) ↓ Download PDF Medicaid denials must be appealed within 45 days. In this case, the petitioner received notices dated April 18, 2023 and August 29, 2023 determining that she was over the asset limit in April, May, and June. But because […] Read more

DHA Case No. MSC 215557 (Wis. Div. Hearings and Appeals Feb. 24, 2025) (DHS) ↓ Download PDF SeniorCare members with income under 200% of the Federal Poverty Level have a $500 deductible; members under 240% have a $850 deductible. In this case, the petitioner had a $850 deductible after his renewal, based on his expected […] Read more