DHA Case No. MED 292938 (Wis. Div. of Hearings and Appeals September 3, 2008) (DHS) ↓ Download PDF Gifts received by a Medicaid recipient must be reported within ten days. In this case, the petitioner was disabled with cancer. Her community held a fundraiser and gave her almost $30,000, which she failed to report. Although […] Read more
ALJ Michael D. O’Brien
DHA Case No. FCP 163632 (Wis. Div. of Hearings and Appeals April 13, 2015) (DHS) ↓ Download PDF Family Care benefits generally cannot be backdated, except that retroactive enrollment can be ordered by an ALJ to correct delay caused by agency error. This is an early case where the agency delayed sending a request for […] Read more
DHA Case No. MAP 196477 (Wis. Div. of Hearings and Appeals January 13, 2020) (DHS) ↓ Download PDF To be eligible for the MAPP program, the individual’s countable assets must be below $15,000. Assets titled solely in a spouse’s name do not count for MAPP. In this case, the Department disenrolled the petitioner, apparently counting […] Read more
DHA Case No. MGE 196854 (Wis. Div. of Hearings and Appeals February 14, 2020) (DHS) ↓ Download PDF For EBD Medicaid programs, a couple’s income is only counted together if they are legally married and living together. In this case, the petitioner lived with his partner, had children with her, had a commitment ceremony, and […] Read more
DHA Case No. MOP 197486 (Wis. Div. of Hearings and Appeals February 27, 2020) (DHS) ↓ Download PDF To establish an overpayment, the Department has the burden of proof by the preponderance of the evidence. In this case, the issue was whether the petitioner’s husband lived with her or not (if so, her household income […] Read more
DHA Case No. MGE 197359 (Wis. Div. of Hearings and Appeals March 4, 2020) (DHS) ↓ Download PDF A community spouse must sign the Medicaid application and verify his or her assets unless a denial would result in undue hardship. In this case, the petitioner moved to a separate home from his wife in the […] Read more
DHA Case No. MGE 197888 (Wis. Div. of Hearings and Appeals March 20, 2020) (DHS) ↓ Download PDF In general, applicants are responsible for verification—but agencies cannot deny eligibility when the applicant has no ability to get the required verification. In this case, the petitioner listed an old timeshare on the Medicaid application but lacked […] Read more
DHA Case No. FCP 177944 (Wis. Div. of Hearings and Appeals December 13, 2016) (DHS) ↓ Download PDF It is a divestment when a life estate is terminated and the life estate holder is not paid her proportional share. In this case, the petitioner’s life estate was divested when she sold her home and her […] Read more
DHA Case No. MGE 143573 (Wis. Div. of Hearings and Appeals March 13, 2013) (DHS) ↓ Download PDF This unusual case is fact-specific, involving the interplay of Community Waiver benefits, the community spouse asset share, and the timing of getting a functional screen from the Aging and Disability Resource Center (ADRC). The issue was that […] Read more
DHA Case No. MDV 146580 (Wis. Div. of Hearings and Appeals April 23, 2013) (DHS) ↓ Download PDF In this divestment case, the petitioner divested $85,000 to relatives. Those same relatives afterward paid about $89,000 for the petitioner’s nursing home care. Despite this, the agency found only a partial cure, arguing that only the payments […] Read more
DHA Case No. MGE 148648 (Wis. Div. of Hearings and Appeals Sep. 4, 2013) (DHS) ↓ Download PDF In this straightforward case, the issue was simply whether paying a private-rate nursing home bill reduced the petitioner’s countable assets. Unsurprisingly, it did. It appears the issue came up because the county chafed against a well-known fact […] Read more
DHA Case No. MGE 170367 (Wis. Div. of Hearings and Appeals March 2, 2016) (DHS) ↓ Download PDF This decision discussed two issues at some length. First, whether payments to the petitioner’s daughter were divestments; and second, whether the petitioner’s former home, now rented at fair market value, was countable. On the first issue, the […] Read more
DHA Case No. MDV 197185 (Wis. Div. Hearings and Appeals Mar. 2, 2020) (DHS) ↓ Download PDF The petitioner’s husband bought an annuity with a term beyond his life expectancy, which is usually a divestment. The ALJ agreed with the argument, however, that the annuity was bought without the intent to qualify for Medicaid, warranting […] Read more
DHA Case No. MGE 174654 (Wis. Div. Hearings and Appeals July 27, 2016) (DHS) ↓ Download PDF In this case, the county required a full five years of financial documentation because “there were a few discrepancies” in the initial documents provided. The applicant complied with more than 600 pages of documentation, plus authorizations for the […] Read more