DHA Case No. FCP 212098 (Wis. Div. of Hearings and Appeals April 26, 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 petitioner claimed to have sent verification of assets being below $2,000 in December—via ACCESS and, a […] Read more

DHA Case No. CWK 211734 (Wis. Div. of Hearings and Appeals April 26, 2024) (DHS) ↓ Download PDF To be eligible for the Children’s Long-Term Support program (CLTS), the child must meet an institutional level of care as determined by the program’s specific functional screen. In this case, the agency sought to disenroll the petitioner […] Read more

DHA Case No. FCP 211909 (Wis. Div. of Hearings and Appeals April 23, 2024) (DHS) ↓ Download PDF An individual is functionally eligible for Family Care if he or she needs a “nursing home” level of care, as determined by the functional screen. In this case, the petitioner’s functional screen found the petitioner functionally ineligible […] Read more

DHA Case No. MGE 211532 (Wis. Div. of Hearings and Appeals April 19, 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 petitioner applied August 8 and Income Maintenance did nothing until September 19, well beyond the 30-day […] Read more

DHA Case No. CWA 211105 (Wis. Div. of Hearings and Appeals April 19, 2024) (DHS) ↓ Download PDF The Department, through IRIS Consulting Agencies (ICAs), must ensure the health and safety of IRIS participants. The IRIS policy manual allows an application to be denied for “inability or unwillingness to develop an Individual Support and Service […] Read more

DHA Case No. FCP 211741 (Wis. Div. of Hearings and Appeals April 17, 2024) (DHS) ↓ Download PDF Beginning on the date of enrollment, an MCO must pay for needed services, including the continuation of current services “necessary to ensure health and safety and continuity of care,” until the full assessment and member-centered plan are […] Read more

DHA Case No. MAP 212440 (Wis. Div. of Hearings and Appeals April 16, 2024) (DHS) ↓ Download PDF Applicants for Medicaid are given at least 20 days from the date of a request to provide verification, and benefits may only be denied if the applicant has the power to produce the verification. In this case, […] Read more

DHA Case No. MAP 211814 (Wis. Div. of Hearings and Appeals April 8, 2024) (DHS) ↓ Download PDF A trust is not an available asset if it was funded by a third party and the Medicaid applicant or member cannot, by the terms of the trust, require the trustee to make distributions. In this case, […] Read more

DHA Case No. MGE 211748 (Wis. Div. of Hearings and Appeals April 3, 2024) (DHS) ↓ Download PDF A person must be a U.S. citizen or qualifying lawful immigrant to be eligible for Medicaid. In this case, the petitioner was an immigrant with “temporary protected status.” Her Medicaid application was mistakenly approved in 2022 and the […] Read more

DHA Case No. MQB 212321 (Wis. Div. of Hearings and Appeals April 2, 2024) (DHS) ↓ Download PDF Income Maintenance agencies must assist Medicaid applicants and members with verification if asked or if they have difficulty in obtaining it. In this case, the petitioner—a 72-year old woman—faxed the required verification of her life insurance, but […] Read more

DHA Case No. MRA 211198 (Wis. Div. of Hearings and Appeals March 28, 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 was diagnosed […] Read more

DHA Case No. MAP 212141 (Wis. Div. of Hearings and Appeals March 27, 2024) (DHS) ↓ Download PDF An asset is considered unavailable if the owner documents that it will not be available for 30 days or more and a process has been started to obtain the assets. In this case, the petitioner could access […] Read more

DHA Case No. FCP 211586 (Wis. Div. of Hearings and Appeals March 26, 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 ADRC told the petitioner not to apply for MA until after the functional screen was completed, […] Read more

DHA Case No. MGE 211383 (Wis. Div. of Hearings and Appeals March 28, 2024) (DHS) ↓ Download PDF The patient liability for an institutionalized person generally leaves only a small amount of money for personal needs ($45 at the time of this case, now $55). In this case, the petitioner complained that her $45 per […] Read more