DHA Case No. BCS 216058 (Wis. Div. Hearings and Appeals Feb. 14, 2025) (DHS) ↓ Download PDF When verifying income with BadgerCare Plus, the agency must “advise the applicant of the specific verification required.” If the applicant “is able to produce required verifications but refuses or fails to do so,” the benefits will be denied […] Read more

DHA Case No. CWA 215403 (Wis. Div. Hearings and Appeals Feb. 5, 2025) (DHS) ↓ Download PDF The IRIS program can pay for residential services, such as those provided in an adult family home (AFH), but “residential services” does not include the cost of room and board. In this case, the petitioner asked to increase […] Read more

DHA Case No. CWA 212613 (Wis. Div. Hearings and Appeals May 30, 2024) (DHS) ↓ Download PDF IRIS participants must pay their providers a “usual and customary rate.” In this case, the petitioner’s supported employment provided asked for a rate increase to maintain a competitive wage for employees and pay for rising health insurance, mileage, […] Read more

DHA Case No. MKB 212148 (Wis. Div. Hearings and Appeals Jun. 18, 2024) (DHS) ↓ Download PDF To be eligible for the Katie Beckett program, a child must qualify as disabled under the Social Security standards in addition to functionally needing an institutional level of care. That often comes down to whether the child’s condition […] Read more

DHA Case No. FCP 212237 (Wis. Div. Hearings and Appeals May 9, 2024) (DHS) ↓ Download PDF Family Care may cover home modifications such as ramps and lifts to provide safe access to the home, reduce risk of injury, and facilitate independence and self-reliance. In this case, the petitioner was an 81-year-old woman unable to […] Read more

DHA Case No. SSO 211439 (Wis. Div. Hearings and Appeals Apr. 2, 2024) (DHS) ↓ Download PDF When recovering a state SSI overpayment, DHS is limited to recovering benefits paid during the twelve months before the overpayment discovery date. Neither the administrative code nor DHS’s SSI policies define “date of discovery.” In the absence of […] Read more

DHA Case No. CWA 211033 (Wis. Div. Hearings and Appeals Feb. 6, 2024) (DHS) ↓ Download PDF To be functionally eligible for the IRIS program, a person must have a long-term care functional screen that determines them to need a “nursing home” level of assistance with activities of daily living (ADLs) and instrumental activities of […] Read more

DHA Case No. CWA 210988 (Wis. Div. Hearings and Appeals Feb. 5, 2024) (DHS) ↓ Download PDF IRIS participants who fail to comply with program requirements or lose functional eligibility may be disenrolled. In this case, the petitioner needed to complete an annual long-term care functional screen but failed to respond to twelve phone calls […] Read more

DHA Case No. CWA 211040 (Wis. Div. Hearings and Appeals Feb. 2, 2024) (DHS) ↓ Download PDF A budget amendment may be denied if it requests services that are duplicative of services already provided. In this case, the petitioner, an 18-year-old with Down Syndrome, requested a budget amendment to allow her to attend a 9-month […] Read more

DHA Case No. CWA 211772 (Wis. Div. of Hearings and Appeals July 2, 2024) (DHS) ↓ Download PDF Late renewals can cause a gap in Community Waivers enrollment, though the Department has allowed for an expedited re-enrollment process to minimize this. In this case, however, the petitioner submitted his renewal timely on the due date […] Read more

DHA Case No. CWA 212695 (Wis. Div. of Hearings and Appeals June 24, 2024) (DHS) ↓ Download PDF Continuing enrollment in IRIS requires payment of the cost share. In this case, the petitioner had $1,102.50 of unpaid cost share that she argued was discharged in a bankruptcy court order. ALJ Teresa Perez concluded she lacked […] Read more

DHA Case No. BCS 213015 (Wis. Div. of Hearings and Appeals June 24, 2024) (DHS) ↓ Download PDF During the Covid public health emergency unwinding, members who had an increase in earned income could qualify for a 12-month extension starting the month after their renewal. In this case, the petitioner qualified for an extension but […] Read more

DHA Case No. MGE 213356 (Wis. Div. of Hearings and Appeals June 20, 2024) (DHS) ↓ Download PDF In this very brief—but slightly horrifying—case, Milwaukee Enrollment Services notified the petitioner that she was no longer eligible for Community Waivers because “you have asked us to stop giving you this benefit.” This was an undisputed error. […] Read more

DHA Case No. CWA 212769 (Wis. Div. of Hearings and Appeals June 10, 2024) (DHS) ↓ Download PDF Continuing functional eligibility for the IRIS program is determined by a yearly functional screen. In this case, the petitioner’s yearly screen found that she no longer needed a helper present while bathing, resulting in a loss of […] Read more