Benjamin S. Wright

DHA Case No. MNP 211393 (Wis. Div. of Hearings and Appeals March 8, 2024) (DHS) ↓ Download PDF Wisconsin Medicaid covers emergency out-of-state services, even if the provider is not certified with Wisconsin Medicaid. In this case, the petitioner had a seizure while in Florida with her family and was transported by ambulance. The ambulance […] Read more

DHA Case No. MAP 211494 (Wis. Div. of Hearings and Appeals March 6, 2024) (DHS) ↓ Download PDF To be exempt homestead property, the property must serve as the individual’s primary place of residence. In this case, the petitioner owned real estate worth $25,000 and claimed he lived there in a tent, providing documents and […] Read more

DHA Case No. CWA 211775 (Wis. Div. of Hearings and Appeals March 5, 2024) (DHS) ↓ Download PDF To be functionally eligible for IRIS, a person must be unable to safely or appropriately perform some combination of activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The Department’s instructions for completing the […] Read more

DHA Case No. MGE 211382 (Wis. Div. of Hearings and Appeals February 29, 2024) (DHS) ↓ Download PDF The asset limit for SSI-related Medicaid is $2,000.00. In this case, the petitioner (a realtor) was able to exempt one vehicle, his homestead, and various properties used for self-employment; but the value of a few small, landlocked […] Read more

DHA Case No. MPP 211770 (Wis. Div. of Hearings and Appeals February 21, 2024) (DHS) ↓ Download PDF If a Medicaid recipient knowingly obtains health care that exceeds program limits or is not medically necessary, the Department may enroll the recipient in the “lock-in program,” which limits the recipient to one prescriber and one pharmacy […] Read more

DHA Case No. MGE 210955 (Wis. Div. of Hearings and Appeals February 21, 2024) (DHS) ↓ Download PDF An institutionalized person can get a home maintenance deduction if he or she verifies the expenses and a physician verifies that the person is likely to return home within six months. In this case, the petitioner was […] Read more

DHA Case No. MLL 211310 (Wis. Div. of Hearings and Appeals February 19, 2024) (DHS) ↓ Download PDF When an heir applies for a hardship waiver of an estate recovery claim, the heir  must include documents establishing his or her relationship to the decedent. In this case, the heir failed to document her relationship, though […] Read more

DHA Case No. FCP 211190 (Wis. Div. of Hearings and Appeals February 12, 2024) (DHS) ↓ Download PDF When applying for Family Care, Income Maintenance and the ADRC have 30 days to make their determinations of financial and functional eligibility. In this case, the petitioner was disenrolled November 1 due to excess assets, which her […] Read more

DHA Case No. FCP 211094 (Wis. Div. of Hearings and Appeals February 12, 2024) (DHS) ↓ Download PDF An MCO must develop an individual service plan that reasonably and effectively addresses the enrollee’s long-term care needs and outcomes, including needs for socialization and activities. In this case, the petitioner’s MCO stopped paying for adult day […] Read more

DHA Case No. CWA 211081 (Wis. Div. of Hearings and Appeals February 8, 2024) (DHS) ↓ Download PDF Tribal General Welfare Assistance (GWA) is exempt income only if it is based on the individual’s demonstration of need. In this case, the petitioner received GWA that was admittedly not based on need. ALJ Peter McCombs concluded […] Read more

DHA Case No. CWA 210975 (Wis. Div. of Hearings and Appeals January 24, 2024) (DHS) ↓ Download PDF One way to be functionally eligible for the IRIS program is to need help with one activity of daily living (ADL) and three instrumental activities of daily living (IADLs) and have a cognitive impairment. In this case, […] Read more

DHA Case No. BCS 211320 (Wis. Div. of Hearings and Appeals January 18, 2024) (DHS) ↓ Download PDF To be eligible for Medicaid, an applicant must verify his or her income. In this case, the petitioner tried to fax the verification from a public library to two different fax numbers, but the agency never received […] Read more

DHA Case No. FCP 210296 (Wis. Div. of Hearings and Appeals March 5, 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 agency denied the application in August after erroneously counting a burial asset. In October, after the […] Read more

DHA Case No. MRA 210683 (Wis. Div. of Hearings and Appeals January 8, 2024) (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 community spouse had many […] Read more