ALJ Michael D. O’Brien

MGE 197359 (03/04/2020)
No hardship waiver for spousal refusal, no evidence of refusal

Tags: 1 Applications and Renewals, 1.1 Applications, 1.1.2 Valid signature, 3 Financial Eligibility, 3.4 Spousal impoverishment, 4 Program Administration, 4.5 Undue hardship, 5 Subprograms, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.1 Family Care, ALJ Michael D. O’Brien

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

MGE 197888 (03/20/2020)
Timeshare incapable of verification

Tags: 3 Financial Eligibility, 3.2 Assets, 3.2.6 Liquid assets, 3.2.6.04 Annuities, 4 Program Administration, 4.1 Verification, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Michael D. O’Brien

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

FCP 177944 (12/13/2016)
Closing costs deducted from divestment amount

Tags: 3 Financial Eligibility, 3.3 Divestment, 3.3.03 Transfers for FMV, 3.3.25 Life estates, 3.3.25.3 Life estate—termination and payment of less than FMV, 5 Subprograms, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.1 Family Care, ALJ Michael D. O’Brien

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

MGE 143573 (03/13/2013)
Community Waivers benefits retroactive one year because of prior appeal

Tags: 5 Subprograms, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.6 Functional screen, 5.05.7 Effective date, ALJ Michael D. O’Brien

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

MDV 146580 (04/23/2013)
Divestment cured by payments for nursing home care

Tags: 3 Financial Eligibility, 3.3 Divestment, 3.3.05 Ownership returned; cure, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Michael D. O’Brien

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

MGE 148648 (09/04/2013)
Payment of nursing home bill reduced countable resources

Tags: 3 Financial Eligibility, 3.2 Assets, 3.2.1 Availability, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Michael D. O’Brien

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

MGE 170367 (03/02/2016)
Rented former home exempted as business property

Tags: 3 Financial Eligibility, 3.2 Assets, 3.2.7 Real property, 3.2.8 Business property, 3.3 Divestment, 3.3.07 Payments to relatives, 3.3.07.2 For services, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Michael D. O’Brien

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

MDV 197185 (03/02/2020)
No divestment for purchase of annuity beyond life expectancy

Tags: 3 Financial Eligibility, 3.3 Divestment, 3.3.06 Transfers made for purpose other than to qualify for Medicaid, 3.3.17 Irrevocable annuities, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Michael D. O’Brien

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

MGE 174654 (07/27/2016)
Over-verification of irrelevant information

Tags: 4 Program Administration, 4.1 Verification, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Michael D. O’Brien

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

Tag: ALJ Michael D. O’Brien