DHA Case No. MGE 173712 (Wis. Div. Hearings and Appeals Sep. 7, 2016) (DHS) ↓ Download PDF To be income-eligible for Institutional MA, an applicant must qualify as either categorically needy (having a very low income) or medically needy, having income less than her monthly need—of which the cost of the nursing home is a […] Read more

DHA Case No. MGE 208717 (Wis. Div. Hearings and Appeals Nov. 26, 2024) (DHS) (decision on cost motion) ↓ Download PDF Under the Wisconsin Equal Access to Justice Act (WEAJA), petitioners who prevail in a fair hearing are entitled to an award of costs unless the agency’s action was “substantially justified.” In this case, the […] Read more

DHA Case No. CWK 212235 (Wis. Div. Hearings and Appeals May 17, 2024) (DHS) ↓ Download PDF To be functionally eligible for the CLTS program, a child must require an institutional level of care and be in a target group (intellectual/developmental disability, physical disability, or mental health disability). In this case, the agency found the […] Read more

DHA Case No. CWK 212281 (Wis. Div. Hearings and Appeals May 20, 2024) (DHS) ↓ Download PDF To be functionally eligible for the CLTS program, a child must require an institutional level of care and be in a target group (intellectual/developmental disability, physical disability, or mental health disability). In this case, the petitioner was found […] Read more

DHA Case No. CWA 212613 (Wis. Div. Hearings and Appeals May 30, 2024) (DHS) ↓ Download PDF IRIS participants must pay their providers a “usual and customary rate.” In this case, the petitioner’s supported employment provided asked for a rate increase to maintain a competitive wage for employees and pay for rising health insurance, mileage, […] Read more

DHA Case No. MKB 212148 (Wis. Div. Hearings and Appeals Jun. 18, 2024) (DHS) ↓ Download PDF To be eligible for the Katie Beckett program, a child must qualify as disabled under the Social Security standards in addition to functionally needing an institutional level of care. That often comes down to whether the child’s condition […] Read more

DHA Case No. MDD 212595 (Wis. Div. Hearings and Appeals May 14, 2024) (DHS) ↓ Download PDF An applicant is not disabled if he or she is still able to perform appropriate types of work. In this case, the petitioner claimed to be disabled because of her diagnoses of extreme social anxiety, bipolar, PTSD, depression, […] Read more

DHA Case No. CWA 212824 (Wis. Div. Hearings and Appeals Jun. 26, 2024) (DHS) ↓ Download PDF The Department may deny an IRIS budget amendment (BA) request if it is not cost-effective or necessary to achieve the participant’s long-term care outcomes. In this case, the petitioner sought a BA to fund a 4% increase in […] Read more

DHA Case No. CWA 212682 (Wis. Div. Hearings and Appeals Jul. 12, 2024) (DHS) ↓ Download PDF Customized goods or services under the IRIS program must generally be necessary and cost-effective. In this case, the petitioner already had one trained service dog (the training was approved in a prior appeal) but wanted IRIS to pay […] Read more

DHA Case No. CWK 212876 (Wis. Div. Hearings and Appeals Jul. 15, 2024) (DHS) ↓ Download PDF The CLTS program covers home modifications that maximize a participant’s independent functioning in their home. In this case, the petitioner was an autistic child with destructive behaviors. His mother requested durable, solid-wood kitchen cabinetry because he would break […] Read more

DHA Case No. CWK 213060 (Wis. Div. Hearings and Appeals Jul. 15, 2024) (DHS) ↓ Download PDF The parent or caretaker of a CLTS participant may have respite services provided in another’s home if the length of stay is 72 hours or less, even if background checks cannot be completed on all the residents in […] Read more

DHA Case No. 212756 (Wis. Div. Hearings and Appeals Aug. 19, 2024) (DHS) ↓ Download PDF To be approved, IRIS home modifications must address long-term care needs that increase independence; or ensure safe, accessible means of ingress/egress to living quarters; or “otherwise provide safe access to rooms, facilities or equipment within the participant’s living quarters.” […] Read more

DHA Case No. CWK 213700 (Wis. Div. Hearings and Appeals Aug. 30, 2024) (DHS) ↓ Download PDF Educational services funded by the Department of Public Instruction cannot also be covered under CLTS’ “Empowerment and Self-Determination Supports” service code. In this case, the petitioner was initially approved to see a one-on-one provider for help with functional […] Read more

DHA Case No. CWA 214423 (Wis. Div. Hearings and Appeals Nov. 6, 2024) (DHS) ↓ Download PDF IRIS funds may only be used for services, supports, or goods that address a long-term support need. In this case, the petitioner asked IRIS to pay for his participant-hired worker’s travel and lodging costs so he could attend […] Read more