DHA Case No. CWA 216117 (Wis. Div. Hearings and Appeals Feb. 11, 2025) (DHS) ↓ Download PDF IRIS benefits may be backdated if agency error causes unreasonable delay. In this case, the petitioner’s renewal was due September 17 and partially submitted on September 18, but a required signature was not provided until October 10, resulting […] Read more

DHA Case No. MGE 213928 (Wis. Div. Hearings and Appeals Jan. 17, 2025) (DHS) ↓ Download PDF The cash surrender value of life insurance is generally a countable asset (unless the total face value of all policies does not exceed $1,500). In this case, the petitioner applied for MA and listed two life insurance policies […] Read more

DHA Case No. FCP 218386 (Wis. Div. Hearings and Appeals Sep. 23, 2025) (DHS) ↓ Download PDF When an agency error causes delay in an individual’s enrollment in an MCO, the Department may adjust the individual’s enrollment date. In this case, the petitioner switched from the IRIS program to the Family Care program with the […] Read more

DHA Case No. FCP 217040 (Wis. Div. Hearings and Appeals Jun. 27, 2025) (DHS) ↓ Download PDF Family Care benefits may be backdated if agency error causes unreasonable delay. In this case, the petitioner was eligible and selected an MCO and enrollment date with the ADRC, but the ADRC worker’s email to the MCO was […] Read more

DHA Case No. CWA 216814 (Wis. Div. Hearings and Appeals Jun. 18, 2025) (DHS) ↓ Download PDF IRIS benefits may be backdated if agency error causes unreasonable delay. In this case, the petitioner mistakenly reported a new life insurance policy during his renewal that was actually owned by his ex-wife. He then had understandable difficulty […] Read more

DHA Case No. FCP 216960 (Wis. Div. Hearings and Appeals May 30, 2025) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the petitioner was enrolled in both MAPP and Family Care; when his MAPP renewal resulted in disenrollment, the […] Read more

DHA Case No. FCP 140118 (Wis. Div. Hearings and Appeals Jul. 13, 2012) (DHS) ↓ Download PDF Adivestment occurs when an institutionalized individual or spouse transfers assets for less than fair market value during the look-back period. In this case, the petitioner’s husband made cash withdrawals of $100,000 and $17,000 shortly before the application for […] Read more

DHA Case No. CWA 216742 (Wis. Div. Hearings and Appeals Aug. 4, 2025) (DHS) ↓ Download PDF Under the Wisconsin Equal Access to Justice Act (WEAJA), petitioners who prevail in a fair hearing are entitled to an award of costs unless the agency’s action was “substantially justified.” In this case, the petitioner successfully appealed the […] Read more

DHA Case No. FCP 216239 (Wis. Div. Hearings and Appeals May 2, 2025) (DHS) ↓ Download PDF ADRCs and IM agencies must generally determine functional and financial eligibility as soon as practical and within 30 days, and Family Care benefits may be backdated if agency error causes a delay in enrollment. In this case, the […] Read more

DHA Case No. CWA 215905 (Wis. Div. Hearings and Appeals Apr. 11, 2025) (DHS) ↓ Download PDF IRIS enrollment and benefits may be backdated if agency error caused unreasonable delay. In this case, the petitioner’s renewal processing was delayed more than a month when a lead worker mistakenly required Letters of the Estate for a […] Read more

DHA Case No. CWA 216742 (Wis. Div. Hearings and Appeals May 14, 2025) (DHS) ↓ Download PDF One service IRIS can provide is Daily Living Skills (DLS), which teaches and improves skills to improve the participant’s independence in daily life. Because it is educational, the service is monitored to ensure progress is being made. In […] Read more

DHA Case No. CWK 215379 (Wis. Div. Hearings and Appeals Dec. 12, 2024) (DHS) ↓ Download PDF Under the approved Waiver, DHS does not allow for the use of personal restraints and strictly limits the use of protective equipment. In this case, the petitioner was an 8-year-old autistic child who needed a diaper but exhibited […] Read more

DHA Case No. MRA 215653 (Wis. Div. Hearings and Appeals Dec. 20, 2024) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” In this case, ALJ Kelly Cochrane summarily ordered the […] Read more

DHA Case No. CWA 214423 (Wis. Div. Hearings and Appeals Nov. 6, 2024) (DHS) ↓ Download PDF IRIS funds may only be used for services, supports, or goods that address a long-term support need. In this case, the petitioner asked IRIS to pay for his participant-hired worker’s travel and lodging costs so he could attend […] Read more