DHA Case No. MQB 212321 (Wis. Div. of Hearings and Appeals April 2, 2024) (DHS) ↓ Download PDF Income Maintenance agencies must assist Medicaid applicants and members with verification if asked or if they have difficulty in obtaining it. In this case, the petitioner—a 72-year old woman—faxed the required verification of her life insurance, but […] Read more

DHA Case No. MAP 212141 (Wis. Div. of Hearings and Appeals March 27, 2024) (DHS) ↓ Download PDF An asset is considered unavailable if the owner documents that it will not be available for 30 days or more and a process has been started to obtain the assets. In this case, the petitioner could access […] Read more

DHA Case No. MED 36/47216 (Wis. Div. of Hearings and Appeals July 24, 2001) (DHS) ↓ Download PDF Wisconsin’s spousal impoverishment law provides that the income of an institutionalized spouse (including a participant in Community Waivers) is not considered available to the community spouse. In this case, DHS had changed its policy so that the […] Read more

DHA Case No. BCS 210387 (Wis. Div. of Hearings and Appeals January 12, 2024) (DHS) ↓ Download PDF In general, BadgerCare Plus counts all taxable income. However, the IRS allows some live-in care providers to list all payments as a business expense; in those circumstances, BadgerCare Plus also does not count these payments as income. […] Read more

DHA Case No. MDD 201432 (Wis. Div. of Hearings and Appeals April 9, 2021) (DHS) ↓ Download PDF To determine if an applicant can engage in substantial gainful activity, the Disability Determination Bureau applies a 5-step test. In the fifth step, the DDB must determine if the person can do any kind of work that […] Read more

DHA Case No. MPA 203721 (Wis. Div. of Hearings and Appeals January 19, 2022) (DHS) ↓ Download PDF To determine the number of approved personal care worker hours, providers use the Personal Care Screening Tool, which can then be adjusted. In this case, the petitioner asked for 29.75 hours per week but was only approved […] Read more

DHA Case No. MED-40/46891 (Wis. Div. of Hearings and Appeals March 29, 2001) (DHS)  ↓ Download PDF In a spousal impoverishment case, the Wisconsin administrative code provides that funds “expressly set aside” for burial expenses are not countable. In this case, the petitioner’s attorney told the county agency, in writing, that $3,000 in a certain […] Read more

DHA Case No. MPC-13/78330 (Wis. Div. of Hearings and Appeals November 1, 2006) (DHS)  ↓ Download PDF In Community Waivers cases, countable income is first used in eligibility determinations to place an applicant into a group; then the post-eligibility cost share is calculated based on the formula for that group. In this case, the petitioner’s […] Read more

DHA Case No. MDV-37/88496 (Wis. Div. of Hearings and Appeals May 16, 2008) (DHS)  ↓ Download PDF Promissory notes are commonly used to reduce countable resources for Medicaid eligibility. The rules require the note to have a repayment term within the applicant’s life expectancy, require equal payments with no balloon payment, prohibit cancellation of the […] Read more