DHA Case No. MQB 215664 (Wis. Div. Hearings and Appeals Dec. 16, 2024) (DHS) ↓ Download PDF Medicaid fair hearing appeals must be filed within 45 days of the negative action. An appeal is considered filed when the written and signed fair hearing request is received by the agency or on its postmarked date, if […] Read more
Tag: ALJ Wendy I. Smith
DHA Case No. MPA 215583 (Wis. Div. Hearings and Appeals Dec. 9, 2024) (DHS) ↓ Download PDF Medicaid covers prescriptions drugs that are medically necessary, guided by agency policy on the effective, appropriate, and cost-effective use of the drug. For anti-obesity drugs, specifically Wegovy, agency policy limits coverage to 12 continuous months, after which the […] Read more
DHA Case No. BCS 215656 (Wis. Div. Hearings and Appeals Dec. 27, 2024) (DHS) ↓ Download PDF A notice requesting verification must be in writing, specific as to the verification required, and allow a minimum of 20 days to provide it. A notice of adverse action must be mailed at least 10 calendar days before […] Read more
DHA Case No. BCS 215161 (Wis. Div. Hearings and Appeals Dec. 18, 2024) (DHS) ↓ Download PDF To be eligible for BadgerCare Plus, a person must meet certain financial and non-financial requirements, including verification of income for self-employment. In this case, the petitioner verified her self-employment income with a partial, unsigned copy of her tax […] Read more
DHA Case No. MGE 215065 (Wis. Div. Hearings and Appeals Nov. 1, 2024) (DHS) ↓ Download PDF For a single person, up to $1,500 can be exempted as a “burial fund” to the extent other exempt burial assets (burial trusts, life-insurance funded burial contracts, exempt life insurance policies, and burial insurance) do not exceed that […] Read more
DHA Case No. MGE 214773 (Wis. Div. Hearings and Appeals Nov. 1, 2024) (DHS) ↓ Download PDF The county agency is required to verify a Medicaid applicant’s income and assets, including potential divestments. In this case, the petitioner reported a $5,000 transfer to his sister for “paid bills” and his bank statements showed withdrawals of […] Read more
DHA Case No. MGE 215261 (Wis. Div. Hearings and Appeals Oct. 21, 2024) (DHS) ↓ Download PDF Community Waivers members who are eligible for any other full-benefit Medicaid program (such as MAPP) are put in Group A and have no cost share; otherwise, they are put in Group B or B Plus and do have […] Read more