DHA Case No. MGE 218412 (Wis. Div. Hearings and Appeals Aug. 25, 2025) (DHS) ↓ Download PDF If a married applicant’s spouse refuses to cooperate with signing the Medicaid application or providing information, the applicant can request an undue hardship waiver of the application denial. That undue hardship request must describe and document “all attempts […] Read more

DHA Case No. FCP 218663 (Wis. Div. Hearings and Appeals Jul. 24, 2025) (DHS) ↓ Download PDF As stated in the recent DMS Ops Memo 25-07, the state must maintain Medicaid coverage while completing regularly scheduled renewals as long as the renewal is received before the end of the month the renewal is due. In […] Read more

DHA Case No. MGE 216988 (Wis. Div. Hearings and Appeals Jul. 14, 2025) (DHS) ↓ Download PDF The transfer of resources for less than fair market value is a divestment resulting in a penalty period. The penalty (for Institutional MA) begins the first date the applicant applied and would have been otherwise eligible. In this […] Read more

DHA Case No. CWA 218281 (Wis. Div. Hearings and Appeals Jun. 25, 2025) (DHS) ↓ Download PDF As stated in the recent DMS Ops Memo 25-07, the state must maintain Medicaid coverage while completing regularly scheduled renewals as long as the renewal is received before the end of the month the renewal is due. In […] Read more

DHA Case No. CWA 217567 (Wis. Div. Hearings and Appeals June 6, 2025) (DHS) ↓ Download PDF IRIS policy requires IRIS Consultant Agencies (ICAs) to provide assistance and education regarding eligibility, including assisting with maintaining financial eligibility at annual renewals. In this case, the petitioner’s ICA failed to help him navigate his annual renewal and […] Read more

DHA Case No. CWA 216813 (Wis. Div. Hearings and Appeals May 9, 2025) (DHS) ↓ Download PDF The IRIS waiver requires IRIS Consultant Agencies (ICAs) to monitor participants’ health and safety, address health and safety concerns with the participant, and ultimately disenroll participants when health and safety concerns remain despite remediation efforts. In this case, […] Read more

DHA Case No. MGE 216305 (Wis. Div. Hearings and Appeals Mar. 24, 2025) (DHS) ↓ Download PDF Income received in a month is not counted as an asset unless and until it is retained into the following month. In this case, the petitioner applied in September and requested backdating to June and July. She submitted […] Read more

DHA Case No. MAP 216925 (Wis. Div. Hearings and Appeals Apr. 24, 2025) (DHS) ↓ Download PDF To be non-financially eligible for MAPP, a person must be working and meet the SSI standard for disability. In this case, the petitioner had laryngeal cancer and was initially determined disabled, but after a year and a half […] Read more

DHA Case No. FCP 214983 (Wis. Div. Hearings and Appeals Jan. 24, 2025) (DHS) ↓ Download PDF ADRCs must determine functional eligibility as soon as practicable, and no later than 30 days after the request for a functional screen. Similarly, IM agencies must generally determine financial and non-financial eligibility within 30 days of the application. […] Read more

DHA Case No. CWA 215300 (Wis. Div. Hearings and Appeals Dec. 17, 2024) (DHS) ↓ Download PDF IRIS participants are assigned a budget, and their IRIS Consultant Agency (ICA) cannot authorize services exceeding that budget. In this case, the petitioner overbilled her supportive home care budget for many months. Her ICA reduced her authorized supportive […] Read more

DHA Case No. CWA 213491 (Wis. Div. Hearings and Appeals Oct. 24, 2024) (DHS) ↓ Download PDF Home modifications for an IRIS participant must be cost-effective. In this case, the petitioner asked that his tub/shower be replaced with a walk-in shower. The accessibility study concluded this was needed and explained why less expensive options would […] Read more

DHA Case No. MGE 216109 (Wis. Div. Hearings and Appeals Feb. 14, 2025) (DHS) ↓ Download PDF To be eligible for Community Waivers Medicaid programs, an individual must be elderly, blind, or disabled. In this case, the petitioner was 28 years old and working full time at $15.50 per hour, though he had at some […] Read more

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