DHA Case No. CWA 202831 (Wis. Div. of Hearings and Appeals November 29, 2021) (DHS) ↓ Download PDF An IRIS participant must use up private duty nursing (PDN) hours before using supportive home care (SHC) or companion care hours. In this case, the petitioner was found eligible for 24/7 PDN services; her supportive home care […] Read more
Tag: ALJ Nicole Bjork
DHA Case No. CWA 195974 (Wis. Div. of Hearings and Appeals January 6, 2020) (DHS) ↓ Download PDF The Department must ensure the health and safety of IRIS participants. The IRIS policy manual allows involuntary disenrollment for “health and safety risks that participants are unable or unwilling to resolve.” In this case, the petitioner refused […] Read more
DHA Case No. FCP 197394 (Wis. Div. of Hearings and Appeals March 9, 2020) (DHS) ↓ Download PDF Benefits cannot be denied for lack of verification unless the member had adequate notice and the ability to produce the required verification. In this case, the petitioner, an incapacitated woman with dementia, moved to a CBRF. The […] Read more
DHA Case No. MDD 199954 (Wis. Div. of Hearings and Appeals January 14, 2021) (DHS) ↓ Download PDF If the Social Security Administration makes a finding of no disability for an SSI or SSDI application within 12 months of a state Medicaid application, that finding is generally binding on the state. In this case, the […] Read more