Fair Hearing Decisions

DHA Case No. FCP 155113 (Wis. Div. of Hearings and Appeals May 14, 2014) (DHS)  ↓ Download PDF The issue in this case was whether overnight caregiver costs counted as a remedial expense, which could be deducted from income before determining the cost share. The agency argued these could not be a remedial expense, relying […] Read more

DHA Case No. MGE 170367 (Wis. Div. of Hearings and Appeals March 2, 2016) (DHS)  ↓ Download PDF This decision discussed two issues at some length. First, whether payments to the petitioner’s daughter were divestments; and second, whether the petitioner’s former home, now rented at fair market value, was countable. On the first issue, the […] Read more

DHA Case No. MGE 160646 (Wis. Div. Hearings and Appeals January 9, 2015) (DHS)  ↓ Download PDF This case involved two main issues: (1) the date the petitioner transferred ownership of a life insurance policy to her Wispact sub-account, and (2) the effect of a pending disability determination on retroactive eligibility. On the first issue, […] Read more

DHA Case No. MGE 185074 (Wis. Div. Hearings and Appeals March 14, 2018) (DHS)  ↓ Download PDF In this straightforward decision, the petitioner owned home property in Michigan but was admitted to a Wisconsin nursing home. Her Medicaid application was denied because the agency “did not receive timely verification of any circumstance that would exempt […] Read more

DHA Case No. MDV 195771 (Wis. Div. Hearings and Appeals January 9, 2020) (DHS)  ↓ Download PDF In this case, the petitioner’s son bought her multi-family residential property, which had also been her home. A bank evaluation estimated the property’s fair market value at $225,000, and the tax assessment bill estimated it at $236,500. The […] Read more

DHA Case No. FCP 193270 (Wis. Div. Hearings and Appeals June 14, 2019) (DHS)  ↓ Download PDF In this case, the petitioner was receiving Family Care and owed monthly room and board to an assisted living facility. Due to an anomaly, the check for December was never delivered, resulting in it being reissued and mailed […] Read more

DHA Case No. FCP 197076 (Wis. Div. Hearings and Appeals Feb. 28, 2020) (DHS)  ↓ Download PDF In this case, the petitioner had a life estate in two properties, one in California and one in Wisconsin. Both were rented. But Dane County DHS did not reduce the petitioner’s cost share to allow her to pay […] Read more

DHA Case No. MED 67/53178 (Wis. Div. Hearings and Appeals Feb. 28, 2003) (DHS)  ↓ Download PDF In this case, a Medicaid recipient failed to report a divestment that occurred after her initial application was approved and benefits had started. The ALJ held that, despite the failure to report, the overpayment of benefits was not […] Read more

DHA Case No. MDV-36/46674 (Wis. Div. Hearings and Appeals Nov. 21, 2000) (DHS)  ↓ Download PDF When a person, or another acting on the person’s behalf, acts to transfer property such as a life estate without receiving fair market value in return, it is a divestment. But what if the transfer happens automatically, because of […] Read more

DHA Case No. MDV 172290 (Wis. Div. Hearings and Appeals June 3, 2016) (DHS)  ↓ Download PDF A divestment can only be cured by returning the entire value of the resource divested. But what if there have been multiple resources divested? Must all cumulative divestments be returned, or can you cure one divestment at a time? In […] Read more

DHA Case No. MDV 197185 (Wis. Div. Hearings and Appeals Mar. 2, 2020) (DHS)  ↓ Download PDF The petitioner’s husband bought an annuity with a term beyond his life expectancy, which is usually a divestment. The ALJ agreed with the argument, however, that the annuity was bought without the intent to qualify for Medicaid, warranting […] Read more

DHA Case No. FCP 177326 (Wis. Div. Hearings and Appeals Feb. 24, 2017) (DHS)  ↓ Download PDF This case supports backdating Family Care eligibility when there is a delay in enrollment due to agency error. “Although there is no retroactive enrollment in the Family Care program, enrollment as of the date established in correction of […] Read more

DHA Case No. MGE 174654 (Wis. Div. Hearings and Appeals July 27, 2016) (DHS)  ↓ Download PDF In this case, the county required a full five years of financial documentation because “there were a few discrepancies” in the initial documents provided. The applicant complied with more than 600 pages of documentation, plus authorizations for the […] Read more

DHA Case No. MRA 167179 (Wis. Div. Hearings and Appeals Dec. 11, 2015) (DHS)  ↓ Download PDF This decision contains the classic “name on the check” rule. If income is paid only to the name of the community spouse, it is not countable as income to the institutionalized spouse—even if the income is from an […] Read more