DHA Case No. CWA 219333 (Wis. Div. Hearings and Appeals Oct. 15, 2025) (DHS) ↓ Download PDF Aperson enrolled in IRIS is required to pay a cost share as a condition of eligibility. In this case, the petitioner had more than $4,000 in overdue cost share and had previously entered a repayment agreement, but failed […] Read more

DHA Case No. CWA 218110 (Wis. Div. Hearings and Appeals Sep. 25, 2025) (DHS) ↓ Download PDF IRIS participants may submit one-time expense requests to pay for goods or services, including adaptive aids such as vehicle modifications. In this case, the petitioner requested a wheelchair and hand-controls conversion after her old vehicle, which had been […] Read more

DHA Case No. MGE 218833 (Wis. Div. Hearings and Appeals Sep. 5, 2025) (DHS) ↓ Download PDF For a single person in the Institutional MA program, the items that may be subtracted from income in determining patient liability are limited. In this case, the petitioner asked that his $70/month life insurance premiums be deducted, noting […] Read more

DHA Case No. CWA 218446 (Wis. Div. Hearings and Appeals Jul. 17, 2025) (DHS) ↓ Download PDF A participant in IRIS may be disenrolled if they lose their Medicaid eligibility after a renewal. In this case, the petitioner completed a FoodShare renewal that the agency mistakenly processed as a Medicaid renewal, even though her Medicaid […] Read more

DHA Case No. MGE 217939 (Wis. Div. Hearings and Appeals Jul. 3, 2025) (DHS) ↓ Download PDF Aparticipant in Institutional MA may have their patient liability reduced to allow them to pay medical or remedial expenses. In this case, the petitioner owed $22,504 in unpaid patient liability due to his brother/POA’s mismanagement, or perhaps theft […] Read more

DHA Case No. CWA 217841 (Wis. Div. Hearings and Appeals Jun. 27, 2025) (DHS) ↓ Download PDF IRIS participants may submit one-time expense requests to pay for goods or services, including adaptive aids such as vehicle modifications. In this case, the petitioner requested a wheelchair conversion for a new SUV, which TMG denied as not […] Read more

DHA Case No. CWA 217154 (Wis. Div. Hearings and Appeals Jun. 17, 2025) (DHS) ↓ Download PDF IRIS participants may be disenrolled if they cannot or will not address health and safety concerns. In this case, the petitioner had seizures and “episodes of disorientation,” during which his caregiver would lock or barricade him in his […] Read more

DHA Case No. CWA 216919 (Wis. Div. Hearings and Appeals May 30, 2025) (DHS) ↓ Download PDF An IRIS participant’s budget is based in their long-term care functional screen. In this case, the petitioner’s Supportive Home Care (SHC) hours were reduced from 22.25 to 5 hour per week, even though his most recent functional screen […] Read more

DHA Case No. CWA 216858 (Wis. Div. Hearings and Appeals May 9, 2025) (DHS) ↓ Download PDF A person is functionally eligible for IRIS if, among other criteria, the person cannot safely or appropriately perform one or more ADL and 3 or more IADLs and has cognitive impairment. In this case, the petitioner was a […] Read more

DHA Case No. CWK 216983 (Wis. Div. Hearings and Appeals Apr. 28, 2025) (DHS) ↓ Download PDF For a CLTS participant age 12 or older, covered “child care” can include school and community-based settings such as after school programs and 4-H. In this case, the petitioner requested funding for two three-week camp programs at the […] Read more

DHA Case No. FCP 216785 (Wis. Div. Hearings and Appeals Apr. 14, 2025) (DHS) ↓ Download PDF To be functionally eligible for home and community based long term care services through the PACE program, an individual must require a “nursing home” level of care. In this case, the petitioner required assistance with one ADL and […] Read more

DHA Case No. WFC 215794 (Wis. Div. Hearings and Appeals Mar. 27, 2025) (DHS) ↓ Download PDF The Wisconsin Funeral and Cemetery Aids Program (WFCAP) pays up to $1,500 of the funeral and burial expenses and up to $1,000 of the cemetery expenses of certain indigent recipients of public benefits. However, the program does not […] Read more

DHA Case No. FCP 216227 (Wis. Div. Hearings and Appeals Mar. 27, 2025) (DHS) ↓ Download PDF A participant in Family Care cannot be disenrolled without proper advance notice. In this case, the petitioner apparently missed a yearly renewal due in August and had difficulty navigating the re-enrollment process with the ADRC (“sometime in December […] Read more

DHA Case No. MRA 216768 (Wis. Div. Hearings and Appeals Mar. 6, 2025) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” In this case, a previous fair hearing decision had […] Read more