DHA Case No. CWA 211353 (Wis. Div. of Hearings and Appeals March 14, 2024) (DHS) ↓ Download PDF DHS automatically disenrolls an IRIS participant when he or she loses basic Medicaid eligibility. In this case, the petitioner failed to get his renewal verification in on time and was disenrolled from Medicaid and IRIS. Although he […] Read more

DHA Case No. MAP 211494 (Wis. Div. of Hearings and Appeals March 6, 2024) (DHS) ↓ Download PDF To be exempt homestead property, the property must serve as the individual’s primary place of residence. In this case, the petitioner owned real estate worth $25,000 and claimed he lived there in a tent, providing documents and […] Read more

DHA Case No. MGE 211382 (Wis. Div. of Hearings and Appeals February 29, 2024) (DHS) ↓ Download PDF The asset limit for SSI-related Medicaid is $2,000.00. In this case, the petitioner (a realtor) was able to exempt one vehicle, his homestead, and various properties used for self-employment; but the value of a few small, landlocked […] Read more

DHA Case No. MGE 210955 (Wis. Div. of Hearings and Appeals February 21, 2024) (DHS) ↓ Download PDF An institutionalized person can get a home maintenance deduction if he or she verifies the expenses and a physician verifies that the person is likely to return home within six months. In this case, the petitioner was […] Read more

DHA Case No. CWA 211081 (Wis. Div. of Hearings and Appeals February 8, 2024) (DHS) ↓ Download PDF Tribal General Welfare Assistance (GWA) is exempt income only if it is based on the individual’s demonstration of need. In this case, the petitioner received GWA that was admittedly not based on need. ALJ Peter McCombs concluded […] Read more

DHA Case No. MGE 175387 (Wis. Div. of Hearings and Appeals September 27, 2016) (DHS) ↓ Download PDF For Institutional Long-Term Care Medicaid, an applicant is income-eligible if they are categorically needy or medically needy. An applicant is medically needy if his or her income does not exceed his or her monthly need, the biggest […] Read more

DHA Case No. MGE 210403 (Wis. Div. of Hearings and Appeals December 8, 2023) (DHS) ↓ Download PDF The assets in an irrevocable trust funded with the petitioner’s property are potentially available if there are any circumstances allowing payment from the trust to the petitioner. In this case, the petitioner established a Hedlund-type trust in 1996 […] Read more

DHA Case No. CWA 208861 (Wis. Div. of Hearings and Appeals November 10, 2023) (DHS) ↓ Download PDF In general, a service covered by IRIS must be necessary and cost-effective. In this case, the petitioner sought an increase in the rate paid to his AFH from $194.37 per day to $309.20 per day. Thanks largely […] Read more

DHA Case No. MGE 209206 (Wis. Div. of Hearings and Appeals November 8, 2023) (DHS) ↓ Download PDF DHA Case No. CWA 209207 (Wis. Div. of Hearings and Appeals November 8, 2023) (DHS) ↓ Download PDF The principal or income of an irrevocable trust funded with a Medicaid applicant’s resources is countable if there are […] Read more

DHA Case No. CWA 210286 (Wis. Div. of Hearings and Appeals November 2, 2023) (DHS) ↓ Download PDF The Department may deny an IRIS application for an inability or unwillingness to develop an Individual Support and Service Plan (ISSP) that ensures the participant’s health and safety. In this case, the petitioner was previously disenrolled in […] Read more

DHA Case No. MGE 210128 (Wis. Div. of Hearings and Appeals November 22, 2023) (DHS) ↓ Download PDF An asset is not available if the member lacks the ability to provide legal access to it. In this case, the petitioner had a life insurance policy with a cash value greater than $2,000; he also had […] Read more

DHA Case No. MDV 209376 (Wis. Div. of Hearings and Appeals October 27, 2023) (DHS) ↓ Download PDF Institutional MA eligibility can be backdated up to three months prior to the the month of application. In this case, the petitioner requested an asset assessment in January 2023 but didn’t apply until May. ALJ Peter McCombs […] Read more

DHA Case No. CWA 198542 (Wis. Div. of Hearings and Appeals July 21, 2020) (DHS) ↓ Download PDF The IRIS program can pay for home modifications that address “disability related long-term care needs that increase self-reliance and independence, or ensure safe, accessible means of ingress/egress to a participant’s living quarters, or otherwise provide safe access […] Read more

DHA Case No. CWA 209455 (Wis. Div. of Hearings and Appeals October 2, 2023) (DHS) ↓ Download PDF An individual is functionally eligible for IRIS if he or she needs a “nursing home” level of care, as determined by the functional screen. In this case, the two most recent functional screens found the petitioner needed […] Read more