In this very brief—but slightly horrifying—case, Milwaukee Enrollment Services notified the petitioner that she was no longer eligible for Community Waivers because “you have asked us to stop giving you this benefit.” This was an undisputed error. ALJ Teresa Perez concluded the petitioner was continuously eligible and ordered the Department to rescind her Family Care disenrollment.
This decision was published with support from the Elder Law & Special Needs Section of the State Bar of Wisconsin and the Wisconsin chapter of the National Academy of Elder Law Attorneys.
Preliminary Recitals
Pursuant to a petition filed on May 6, 2024, under Wis. Stat. § 49.45(5), and Wis. Admin. Code § HA 3.03(1), to review a decision by the Milwaukee Enrollment Services regarding Medical Assistance (MA), a hearing was held on June 19, 2024, by telephone.
The issues for determination are whether Petitioner’s Community Waivers eligibility was properly terminated as of April 1, 2024 and whether she was properly disenrolled from the Family Care Program as of April 30, 2024.
There appeared at that time the following persons:
PARTIES IN INTEREST:
Petitioner:
—
Respondent:
Department of Health Services
1 West Wilson Street, Room 651
Madison, WI 53703
By: Kyra Oberg
Milwaukee Enrollment Services
1220 W Vliet St
Milwaukee, WI 53205
ADMINISTRATIVE LAW JUDGE:
Teresa A. Perez
Division of Hearings and Appeals
Findings of Fact
- Petitioner (CARES # —) is a 69-year old married resident of Milwaukee County who has remained financially and functionally eligible for Family Care since her enrollment in the program in October 2015.
- By notice dated March 18, 2024, Milwaukee Enrollment Services (“MilES”) informed Petitioner that she was no longer eligible for Community Waivers as of April 1, 2024 and identified the following reason for the termination: “You have asked us to stop giving you this benefit.”
- In fact, Petitioner never asked to stop receiving Community Waivers and the April 1, 2024 termination of her Community Waivers eligibility was an agency error.
- Based on MilES’s erroneous termination of Petitioner’s Community Waivers eligibility, MyChoice Family Care disenrolled Petitioner from Family Care as of April 30, 2024.
- On May 6, 2024, Petitioner filed a request for fair hearing with the Division of Hearings and Appeals.
Discussion
The facts here are undisputed: Petitioner was terminated from Community Waivers on April 1, 2024 and disenrolled from Family Care on April 30, 2024 in error. Petitioner has remained continuously functionally and financially eligible for these related programs.
Conclusions of Law
- Petitioner’s eligibility for Community Waivers was terminated in error on April 1, 2024 which caused her to be improperly disenrolled from Family Care as of April 30, 2024.
- Petitioner has been continuously eligible for and entitled to Community Waivers Medicaid and Family Care since October 15, 2021.
THEREFORE, it is
Ordered
That the matter is remanded to Milwaukee Enrollment Services and to the Department of Health Services and its contractors, the Milwaukee County ADRC and MyChoice Family Care, to take all administrative steps necessary to: (1) rescind Petitioner’s disenrollment from Family Care and re-enroll her in Family Care as of April 30, 2024, and (2) to re-open her Community Waivers effective April 1, 2024. The agencies shall comply with this order within ten days of the date of this decision.
[Request for a rehearing and appeal to court instructions omitted.]