DHA Case No. FCP 210801 (Wis. Div. Hearings and Appeals Jan. 3, 2024) (DHS) ↓ Download PDF To be functionally eligible for Family Care, a person must fall into one of the program’s target groups in addition to needing a nursing home level of care. In this case, the petitioner was diagnosed with schizophrenia and […] Read more

DHA Case No. CWA 210721 (Wis. Div. Hearings and Appeals Jan. 3, 2024) (DHS) ↓ Download PDF The IRIS program can cover home modifications, but they must address the participant’s independence, health, safety, or long-term care needs and be cost effective. In this case, the petitioner made a one-time expense request to pay for a […] Read more

DHA Case No. CWA 214809 (Wis. Div. Hearings and Appeals Oct. 31, 2024) (DHS) ↓ Download PDF Because CLTS is the payor of last resort, all other benefits available to a participant must be accessed before the waiver funding may be used. In this case, the petitioner’s insurance covered speech therapy, but not the specific […] Read more

DHA Case No. CWA 213161 (Wis. Div. Hearings and Appeals Oct. 28, 2024) (DHS) ↓ Download PDF The Department must ensure the health and safety of IRIS participants. The IRIS policy manual allows involuntary disenrollment for “health and safety risks that participants are unable or unwilling to resolve.” In this case, the participant was a […] Read more

DHA Case No. MDV 214370 (Wis. Div. Hearings and Appeals Oct. 22, 2024) (DHS) ↓ Download PDF The transfer of an exempt asset (except a homestead) is not a divestment. In this case, the petitioner bought a car—though she could not drive herself—that her son used to transport her to medical appointments. About seven months […] Read more

DHA Case No. MDD 214689 (Wis. Div. Hearings and Appeals Oct. 21, 2024) (DHS) ↓ Download PDF If the Social Security Administration finds an applicant not disabled within twelve months of a state MA application, that determination is binding on the state. In this case, the petitioner applied for SSI, SSDI, and state MA. Because […] Read more

DHA Case No. CWA 213537 (Wis. Div. Hearings and Appeals Oct. 18, 2024) (DHS) ↓ Download PDF The IRIS Policy Manual requires a notice of action and provides a right to appeal when services are reduced, terminated, or denied. In this case, the petitioner’s care worker failed to timely submit the required documentation to become […] Read more

DHA Case No. MRA 213346 (Wis. Div. Hearings and Appeals Aug. 30, 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, ALJ Nicole Bjork increased the CSIA […] Read more

DHA Case No. FCP 213736 (Wis. Div. Hearings and Appeals Aug. 28, 2024) (DHS) ↓ Download PDF A participant in Family Care can be involuntarily disenrolled if they are determined ineligible for MA. In this case, the petitioner submitted his renewal timely and was eligible, but his MCO disenrolled him in error and could not […] Read more

DHA Case No. MKB 214020 (Wis. Div. Hearings and Appeals Oct. 17, 2024) (DHS) ↓ Download PDF To be considered disabled for the Katie Beckett program, a child must have an impairment that causes marked and severe functional limitations. In this case, a 5-year-old girl was determined no longer eligible after her recertification in January […] Read more

DHA Case No. MKB 213737 (Wis. Div. Hearings and Appeals Aug. 22, 2024) (DHS) ↓ Download PDF To be considered disabled for the Katie Beckett program, a child must have an impairment that causes marked and severe functional limitations. In this case, a 4-year-old boy’s application was denied because his speech delay, pediatric feeding disorder, […] Read more

DHA Case No. MKB 213619 (Wis. Div. Hearings and Appeals Aug. 12, 2024) (DHS) ↓ Download PDF To be considered disabled for the Katie Beckett program, a child must have an impairment that causes marked and severe functional limitations. In this case, the petitioner was a 15-year-old boy who had hearing loss, narcolepsy, and sleep […] Read more

DHA Case No. CWA 213277 (Wis. Div. Hearings and Appeals Sep. 27, 2024) (DHS) ↓ Download PDF An IRIS participant may be involuntarily disenrolled for mismanagement of employer authority responsibilities. In this case, the petitioner had multiple instances of mismanagement with participant-hired workers, including calling the Fiscal Employer Agency posing as one of her workers, […] Read more

DHA Case No. FCP 213572 (Wis. Div. Hearings and Appeals Sep. 24, 2024) (DHS) ↓ Download PDF A service that is “duplicative with respect to other services being provided” is not medically necessary. In this case, the petitioner attended after-hours recreational activities in the community while living with her mother for many years. But when […] Read more