Benjamin S. Wright

DHA Case No. FCP 192893 (Wis. Div. of Hearings and Appeals November 5, 2019) (DHS) ↓ Download PDF An ALJ may issue a proposed decision asking the DHS Secretary to backdate enrollment in Family Care if the normal enrollment date was unnecessarily delayed by either the ADRC or Income Maintenance. In this case, both the […] Read more

DHA Case No. FCP 207387 (Wis. Div. of Hearings and Appeals March 30, 2023) (DHS) ↓ Download PDF An ALJ may issue a proposed decision asking the DHS Secretary to backdate enrollment in Family Care if the normal enrollment date was unnecessarily delayed by either the ADRC or Income Maintenance. In this case, both the […] Read more

DHA Case No. MGE 207256 (Wis. Div. of Hearings and Appeals April 12, 2023) (DHS) ↓ Download PDF Medicaid applicants are required to verify all countable assets. In this case, the petitioner’s application for MA noted that her spouse sold shares of stock in June and July of 2022. She failed to provide verification of […] Read more

DHA Case No. FCP 206978 (Wis. Div. of Hearings and Appeals April 7, 2023) (DHS) ↓ Download PDF In the Family Care program, the MCO must develop an Individual Service Plan (ISP) that reasonably and effectively addresses the enrollee’s long-term care needs and outcomes and is cost-effective. In this case, Community Care ended the petitioner’s […] Read more

DHA Case No. CWA 207243 (Wis. Div. of Hearings and Appeals May 19, 2023) (DHS) ↓ Download PDF The Department must ensure the health and safety of IRIS participants. The IRIS policy manual allows involuntary disenrollment for “health and safety risks that participants are unable or unwilling to resolve.” In this case, the petitioner’s mother […] Read more

DHA Case No. FCP 206782 (Wis. Div. of Hearings and Appeals January 11, 2023) (DHS) ↓ Download PDF To be functionally eligible for Family Care, a person must fall into one of the program’s target groups in addition to needing a nursing home level of care. In this case, the petitioner needed help with one […] Read more

DHA Case No. FCP 206604 (Wis. Div. of Hearings and Appeals January 5, 2023) (DHS) ↓ Download PDF Family Care members in Group A (due to eligibility for MAPP, for example) do not have a cost share. In this complex case, the petitioner lost MAPP eligibility when her child turned 18 and her fiscal test […] Read more

DHA Case No. CWA 206737 (Wis. Div. of Hearings and Appeals January 18, 2023) (DHS) ↓ Download PDF The IRIS Policy Manual allows involuntary disenrollment for “mismanagement of employer authority.” In this case, the petitioner’s son and approved personal care worker became incarcerated; then the petitioner’s grandson, who had the same name, took over care […] Read more

DHA Case No. FCP 203910 (Wis. Div. of Hearings and Appeals March 23, 2023) (DHS) ↓ Download PDF If payments to a relative for services exceed 10% of the maximum CSAS, the MEH requires a notarized agreement. In this case, the petitioner had an agreement to pay her daughters $500 per month, but it was […] Read more

DHA Case No. MQB 209768 (Wis. Div. of Hearings and Appeals November 14, 2023) (DHS) ↓ Download PDF QMB benefits normally begin on the first of the month after the month the person is determined eligible. In this case, the petitioner became eligible for Medicare in June but did not finish verification until July 5, […] Read more

DHA Case No. MGE 209995 (Wis. Div. of Hearings and Appeals December 1, 2023) (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, the agency did not explain […] Read more

DHA Case No. MGE 209934 (Wis. Div. of Hearings and Appeals November 13, 2023) (DHS) ↓ Download PDF Collectibles acquired or held because of their value as an investment are countable assets. In this case, the petitioner owned sports memorabilia worth about $35,000 but argued the collection was (1) unavailable due to the time it […] Read more

DHA Case No. MQB 209568 (Wis. Div. of Hearings and Appeals October 2, 2023) (DHS) ↓ Download PDF With the Public Health Emergency unwinding, members may voluntarily complete an early renewal, but Income Maintenance agencies must inform members that their eligibility may be impacted by doing an early renewal. In this case, the member’s renewal […] Read more

DHA Case No. MGE 209285 (Wis. Div. of Hearings and Appeals September 19, 2023) (DHS) ↓ Download PDF Vehicles used for transportation can be countable assets (apart from one exempt vehicle), but household goods used for maintenance, use, and occupancy of the premises are not countable. In this case, the petitioner’s Medicaid application was denied […] Read more