DHA Case No. MGE 209717 (Wis. Div. of Hearings and Appeals January 5, 2024) (DHS) ↓ Download PDF To be eligible for SSI-related Medicaid, an unmarried individual’s countable assets must be less than $2,000. The individual must also provide the necessary verification. In this case, the petitioner received a VA lump sum payment and was […] Read more
Benjamin S. Wright
DHA Case No. MGE 209474 (Wis. Div. of Hearings and Appeals January 5, 2024) (DHS) ↓ Download PDF To exempt funds in a pooled trust, an applicant for Medicaid must have a formal disability determination. In this case, the petitioner applied for community waivers Medicaid after establishing a pooled trust sub-account. Because he did not […] Read more
DHA Case No. MGE 169735 (Wis. Div. of Hearings and Appeals May 3, 2016) (DHS) ↓ Download PDF Applicants for Medicaid must verify their assets, but workers cannot deny eligibility if the applicant lacks the ability to produce verification. In this case, the petitioner was incompetent and her representatives—her son and lawyer—were unable to verify […] Read more
DHA Case No. MED 36/47216 (Wis. Div. of Hearings and Appeals July 24, 2001) (DHS) ↓ Download PDF Wisconsin’s spousal impoverishment law provides that the income of an institutionalized spouse (including a participant in Community Waivers) is not considered available to the community spouse. In this case, DHS had changed its policy so that the […] Read more
DHA Case No. MGE 162960 (Wis. Div. of Hearings and Appeals March 6, 2015) (DHS) ↓ Download PDF In a spousal impoverishment case, any assets designated for burial purposes are exempt (as long as the amount is reasonable). In this case, the petitioner designated stocks and an insurance policy as burial funds on his November […] Read more
DHA Case No. MGE 175387 (Wis. Div. of Hearings and Appeals September 27, 2016) (DHS) ↓ Download PDF For Institutional Long-Term Care Medicaid, an applicant is income-eligible if they are categorically needy or medically needy. An applicant is medically needy if his or her income does not exceed his or her monthly need, the biggest […] Read more
DHA Case No. MDV 50/105459 (Wis. Div. of Hearings and Appeals September 1, 2009) (DHS) ↓ Download PDF A divestment does not make a person ineligible for Medicaid if the resource was transferred exclusively for some purpose other than to become eligible. In this case, the petitioner’s daughter transferred $7,064.85 to herself so she could […] Read more
DHA Case No. MED 40/68266 (Wis. Div. of Hearings and Appeals June 27, 2005) (DHS) ↓ Download PDF A Medicaid recipient whose income exceeds the “medically needy” income limit must pay a deductible, which can be met by incurring medical expenses. In this case, the petitioner incurred charges for mental health services at the Milwaukee […] Read more
DHA Case No. MED 14/72307 (Wis. Div. of Hearings and Appeals March 17, 2006) (DHS) ↓ Download PDF Institutionalized MA recipients must pay their income towards their cost of care, but are allowed a deduction to pay for medical expenses not covered by MA. In this case, the petitioner owed the nursing home $3,500 for […] Read more
DHA Case No. MLL 171792 (Wis. Div. of Hearings and Appeals March 21, 2016) (DHS) ↓ Download PDF Estate Recovery must file a claim or lien against the estate of decedents who received long-term care Medicaid benefits. In this case, the petitioner challenged the Department’s intent to file a lien against his mother’s estate, arguing […] Read more
DHA Case No. MDV 40/68902 (Wis. Div. of Hearings and Appeals May 18, 2005) (DHS) ↓ Download PDF An institutionalized person may transfer homestead property to their child if the child lived with them and provided care keeping them out of an institution for at least two years immediately before becoming institutionalized. In this case, […] Read more
DHA Case No. MDV 40/54978 (Wis. Div. of Hearings and Appeals December 5, 2002) (DHS) ↓ Download PDF An institutionalized person may transfer homestead property to their child if the child lived with them and provided care keeping them out of an institution for at least two years immediately before becoming institutionalized. In this case, […] Read more
DHA Case No. MDV 49/44514 (Wis. Div. of Hearings and Appeals June 19, 2000) (DHS) ↓ Download PDF To qualify for the caretaker child exception to divestment, the child must “reside in” the institutionalized person’s home in addition to taking care of them. In this case, the petitioner’s son lived in his own, separately-taxed mobile […] Read more
DHA Case No. BCS 210387 (Wis. Div. of Hearings and Appeals January 12, 2024) (DHS) ↓ Download PDF In general, BadgerCare Plus counts all taxable income. However, the IRS allows some live-in care providers to list all payments as a business expense; in those circumstances, BadgerCare Plus also does not count these payments as income. […] Read more
DHA Case No. CWA 209367 (Wis. Div. of Hearings and Appeals January 4, 2024) (DHS) ↓ Download PDF Community Waivers enrollment can be backdated if agency error causes unreasonable delay. In this complicated case, the petitioner was first enrolled in IRIS during the pandemic as a 17- or 18-year-old under his mother’s name. His mother […] Read more