Benjamin S. Wright

DHA Case No. CWA 212769 (Wis. Div. of Hearings and Appeals June 10, 2024) (DHS) ↓ Download PDF Continuing functional eligibility for the IRIS program is determined by a yearly functional screen. In this case, the petitioner’s yearly screen found that she no longer needed a helper present while bathing, resulting in a loss of […] Read more

DHA Case No. CWA 212112 (Wis. Div. of Hearings and Appeals June 7, 2024) (DHS) ↓ Download PDF IRIS may pay for a vehicle modification as a one-time expense (OTE) request, but it must be cost-effective and all other options for funding must be exhausted first. In this case, the 20-year-old petitioner requested a $102,000 […] Read more

DHA Case No. CWA 212568 (Wis. Div. of Hearings and Appeals June 6, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the petitioner was determined functionally and financially eligible as of December 14, but Income Maintenance simply failed […] Read more

DHA Case No. MGE 211474 (Wis. Div. of Hearings and Appeals May 20, 2024) (DHS) ↓ Download PDF IRIS Consultant Agencies (ICAs) must now help participants maintain MA eligibility, including monitoring and reporting any medical or remedial expenses. In this case, the petitioner had more than $2,000 in privately paid personal care expenses that were […] Read more

DHA Case No. MGE 212097 (Wis. Div. of Hearings and Appeals May 6, 2024) (DHS) ↓ Download PDF When there is a change in anticipated self-employment earnings, the MEH generally requires the agency to average the most recent months of earnings that reflect the changed circumstances. In this case, the petitioner had royalty income from […] Read more

DHA Case No. BCS 212166 (Wis. Div. of Hearings and Appeals May 10, 2024) (DHS) ↓ Download PDF The county agency must give individuals adequate written notice of verification requests. In this case, the agency sought to verify whether the petitioner was residing with her estranged spouse. The notice, however, only requested verification of “people […] Read more

DHA Case No. MGE 212254 (Wis. Div. of Hearings and Appeals April 29, 2024) (DHS) ↓ Download PDF The cash value of annuities that can be surrendered is a countable asset. In this case, the petitioner’s annuity had a cash value of about $24,000 but was scheduled to annuitize in less than a year, at […] Read more

DHA Case No. FCP 212098 (Wis. Div. of Hearings and Appeals April 26, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the petitioner claimed to have sent verification of assets being below $2,000 in December—via ACCESS and, a […] Read more

DHA Case No. CWK 211734 (Wis. Div. of Hearings and Appeals April 26, 2024) (DHS) ↓ Download PDF To be eligible for the Children’s Long-Term Support program (CLTS), the child must meet an institutional level of care as determined by the program’s specific functional screen. In this case, the agency sought to disenroll the petitioner […] Read more

DHA Case No. FCP 211909 (Wis. Div. of Hearings and Appeals April 23, 2024) (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. In this case, the petitioner’s functional screen found the petitioner functionally ineligible […] Read more

DHA Case No. MGE 211532 (Wis. Div. of Hearings and Appeals April 19, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the petitioner applied August 8 and Income Maintenance did nothing until September 19, well beyond the 30-day […] Read more

DHA Case No. CWA 211105 (Wis. Div. of Hearings and Appeals April 19, 2024) (DHS) ↓ Download PDF The Department, through IRIS Consulting Agencies (ICAs), must ensure the health and safety of IRIS participants. The IRIS policy manual allows an application to be denied for “inability or unwillingness to develop an Individual Support and Service […] Read more

DHA Case No. FCP 211741 (Wis. Div. of Hearings and Appeals April 17, 2024) (DHS) ↓ Download PDF Beginning on the date of enrollment, an MCO must pay for needed services, including the continuation of current services “necessary to ensure health and safety and continuity of care,” until the full assessment and member-centered plan are […] Read more

DHA Case No. MAP 212440 (Wis. Div. of Hearings and Appeals April 16, 2024) (DHS) ↓ Download PDF Applicants for Medicaid are given at least 20 days from the date of a request to provide verification, and benefits may only be denied if the applicant has the power to produce the verification. In this case, […] Read more