DHA Case No. MGE 211311 (Wis. Div. of Hearings and Appeals March 19, 2024) (DHS) ↓ Download PDF Tribal General Welfare Assistance (GWA) is exempt income only if it is based on the individual’s demonstration of need. In this case, the petitioner received GWA that was apparently not based on need. ALJ Teresa Perez concluded […] Read more

DHA Case No. FCP 211940 (Wis. Div. of Hearings and Appeals March 19, 2024) (DHS) ↓ Download PDF In general, all Family Care services must be authorized before they are provided. In this case, the petitioner’s assisted living facility closed and he had to move to a new one. My Choice staff met with him […] Read more

DHA Case No. MLL 211983 (Wis. Div. of Hearings and Appeals March 18, 2024) (DHS) ↓ Download PDF A hardship waiver for estate recovery must be mailed within 45 days of the notice from DHS. In this tragic case, the waiver was due December 25. The petitioner called Estate Recovery on December 18 to ask […] Read more

DHA Case No. MGE 211566 (Wis. Div. of Hearings and Appeals March 15, 2024) (DHS) ↓ Download PDF Countable assets do not include income received that month and money that is not available. In this case, the petitioner’s eligibility for July was denied because the agency counted $1,599 in Social Security (deposited July 3) and […] Read more

DHA Case No. CWK 210726 (Wis. Div. of Hearings and Appeals March 15, 2024) (DHS) ↓ Download PDF Individual choice of provider is a main tenant of the CLTS program. Even when a background check on a proposed provider reveals negative—but not disqualifying—findings, the County Waiver Agency must respect the participant’s choice “unless there is […] Read more

DHA Case No. CWA 211353 (Wis. Div. of Hearings and Appeals March 14, 2024) (DHS) ↓ Download PDF DHS automatically disenrolls an IRIS participant when he or she loses basic Medicaid eligibility. In this case, the petitioner failed to get his renewal verification in on time and was disenrolled from Medicaid and IRIS. Although he […] Read more

DHA Case No. MDV 210958 (Wis. Div. of Hearings and Appeals March 13, 2024) (DHS) ↓ Download PDF The fair market value of real estate may be established by assessment, statements from realtors, or a comparative market analysis. In this case, the agency relied solely on the fair market value estimate it found on Zillow […] Read more

DHA Case No. MNP 211393 (Wis. Div. of Hearings and Appeals March 8, 2024) (DHS) ↓ Download PDF Wisconsin Medicaid covers emergency out-of-state services, even if the provider is not certified with Wisconsin Medicaid. In this case, the petitioner had a seizure while in Florida with her family and was transported by ambulance. The ambulance […] Read more

DHA Case No. MAP 211494 (Wis. Div. of Hearings and Appeals March 6, 2024) (DHS) ↓ Download PDF To be exempt homestead property, the property must serve as the individual’s primary place of residence. In this case, the petitioner owned real estate worth $25,000 and claimed he lived there in a tent, providing documents and […] Read more

DHA Case No. CWA 211775 (Wis. Div. of Hearings and Appeals March 5, 2024) (DHS) ↓ Download PDF To be functionally eligible for IRIS, a person must be unable to safely or appropriately perform some combination of activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The Department’s instructions for completing the […] Read more

DHA Case No. MGE 211382 (Wis. Div. of Hearings and Appeals February 29, 2024) (DHS) ↓ Download PDF The asset limit for SSI-related Medicaid is $2,000.00. In this case, the petitioner (a realtor) was able to exempt one vehicle, his homestead, and various properties used for self-employment; but the value of a few small, landlocked […] Read more

DHA Case No. MPP 211770 (Wis. Div. of Hearings and Appeals February 21, 2024) (DHS) ↓ Download PDF If a Medicaid recipient knowingly obtains health care that exceeds program limits or is not medically necessary, the Department may enroll the recipient in the “lock-in program,” which limits the recipient to one prescriber and one pharmacy […] Read more

DHA Case No. MGE 210955 (Wis. Div. of Hearings and Appeals February 21, 2024) (DHS) ↓ Download PDF An institutionalized person can get a home maintenance deduction if he or she verifies the expenses and a physician verifies that the person is likely to return home within six months. In this case, the petitioner was […] Read more

DHA Case No. MLL 211310 (Wis. Div. of Hearings and Appeals February 19, 2024) (DHS) ↓ Download PDF When an heir applies for a hardship waiver of an estate recovery claim, the heir  must include documents establishing his or her relationship to the decedent. In this case, the heir failed to document her relationship, though […] Read more