DHA Case No. BCS 207395 (Wis. Div. of Hearings and Appeals March 28, 2023) (DHS) ↓ Download PDF A Notice of Proof Needed must advise the applicant of the specific verification required. In this case, the petitioner received a notice requesting proof of “TUITION: Amount of student loan or grant funds and how they are […] Read more
Tag: ALJ Teresa A. Perez
DHA Case No. BCS 207323 (Wis. Div. of Hearings and Appeals March 15, 2023) (DHS) ↓ Download PDF BadgerCare Plus benefits can be backdated up to three months if the petitioner meets all eligibility requirements in those months. In this case, the petitioner requested backdating but his tax documents did not list any business expenses, […] Read more
DHA Case No. FCP 197060 (Wis. Div. of Hearings and Appeals February 10, 2020) (DHS) ↓ Download PDF An individual is functionally eligible for Family Care if he or she needs a “nursing home” level of care, as determined by the functional screen. This level of care includes those who cannot safely or appropriately perform […] Read more
MGE 198010 (03/27/2020)
Agency failed to screen for Institutional eligibility after CW disenrollment
DHA Case No. MGE 198010 (Wis. Div. of Hearings and Appeals March 27, 2020) (DHS) ↓ Download PDF When a member disenrolls from a managed long-term care program, DHS’s policy is to automatically test for eligibility for non-waivers programs. In this case, the petitioner voluntarily disenrolled from Family Care after moving to a nursing home […] Read more
DHA Case No. MOP 200346 (Wis. Div. of Hearings and Appeals February 10, 2021) (DHS) ↓ Download PDF In an overpayment hearing, the agency has the burden to prove, by the preponderance of the evidence, both that the petitioner failed to provide accurate or complete information and that the petitioner was not eligible during the […] Read more
DHA Case No. MDD 203616 (Wis. Div. of Hearings and Appeals January 19, 2022) (DHS) ↓ Download PDF Even if a person cannot engage in any substantial gainful activity, he must still pass a 5-step test to be determined disabled. If he can perform work he has done in the past, Step 4 requires a […] Read more
DHA Case No. FCP 181279 (Wis. Div. of Hearings and Appeals January 22, 2018) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook allows business property to be exempted—regardless of value or rate of return—if the individual is “actively involved in the business operation on a day-to-day basis.” In this case, the petitioner had a history of renting […] Read more
DHA Case No. FCP 193270 (Wis. Div. Hearings and Appeals June 14, 2019) (DHS) ↓ Download PDF In this case, the petitioner was receiving Family Care and owed monthly room and board to an assisted living facility. Due to an anomaly, the check for December was never delivered, resulting in it being reissued and mailed […] Read more