DHA Case No. MGE 220307 (Wis. Div. Hearings and Appeals Jan. 12, 2026) (DHS) ↓ Download PDF To be eligible for Family Care, an applicant must have a long-term care functional screen to determine his or her functional eligibility. In this case, the petitioner submitted an online ACCESS application indicating that she needed help with […] Read more

DHA Case No. BCS 220537 (Wis. Div. Hearings and Appeals Jan. 9, 2026) (DHS) ↓ Download PDF Neither the administrative code nor the federal regulations include a right to a fair hearing regarding an agency’s failure to close a case promptly when asked to do so by a benefit recipient. In this case, the petitioner […] Read more

DHA Case No. MGE 220918 (Wis. Div. Hearings and Appeals Feb. 6, 2026) (DHS) ↓ Download PDF The MEH says a faxed application received after business hours is considered filed on the next business day, but a 2023 fair hearing decision—adopted as final by the DHS secretary—concluded it should be considered filed the day it […] Read more

DHA Case No. MGE 220701 (Wis. Div. Hearings and Appeals Feb. 3, 2026) (DHS) ↓ Download PDF A person’s income and assets are mandatory verification items at the time of a Medicaid application and at annual renewals. In this case, the petitioner provided, over several rounds of requests, verification of her various assets and spend-down; […] Read more

DHA Case No. BCS 219604 (Wis. Div. Hearings and Appeals Sep. 29, 2025) (DHS) ↓ Download PDF In this case, the petitioners filed a Marketplace application for health insurance that erroneously omitted their income. They corrected this within an hour, but not before the system sent their no-income application to the consortium for BadgerCare Plus, […] Read more

DHA Case No. MGE 218412 (Wis. Div. Hearings and Appeals Aug. 25, 2025) (DHS) ↓ Download PDF If a married applicant’s spouse refuses to cooperate with signing the Medicaid application or providing information, the applicant can request an undue hardship waiver of the application denial. That undue hardship request must describe and document “all attempts […] Read more

DHA Case No. MGE 217686 (Wis. Div. Hearings and Appeals Jun. 17, 2025) (DHS) ↓ Download PDF Eligibility for Institutional MA can be backdated up to three months before the month of application. In this case, the petitioner applied several times over many months and repeatedly failed to provide required verification by the deadline. Ultimately, […] Read more

DHA Case No. MGE 216012 (Wis. Div. Hearings and Appeals Feb. 18, 2025) (DHS) ↓ Download PDF A notice is not adequate if it does not expressly identify the program for which benefits are denied. Also, an application cannot be denied merely because the applicant lacks the power to produce verification. In this case, the […] Read more

DHA Case No. MDV 67/105685 (Wis. Div. Hearings and Appeals 2009) (DHS) ↓ Download PDF A divestment penalty period does not start until the individual is institutionalized, has applied for Medicaid, and is “otherwise eligible,” according to DHS policy effective since 2009. In this early case applying the new policy, the petitioner applied in February […] Read more

DHA Case No. MGE 216329 (Wis. Div. Hearings and Appeals May 9, 2025) (DHS) ↓ Download PDF When an agency error causes a delay in an individual’s enrollment in Family Care, the enrollment date may be adjusted. In this case, the petitioner submitted his 183-page Medicaid application in three faxes on October 29 and received […] Read more

DHA Case No. FCP 216239 (Wis. Div. Hearings and Appeals May 2, 2025) (DHS) ↓ Download PDF ADRCs and IM agencies must generally determine functional and financial eligibility as soon as practical and within 30 days, and Family Care benefits may be backdated if agency error causes a delay in enrollment. In this case, the […] Read more

DHA Case No. CWA 215905 (Wis. Div. Hearings and Appeals Apr. 11, 2025) (DHS) ↓ Download PDF IRIS enrollment and benefits may be backdated if agency error caused unreasonable delay. In this case, the petitioner’s renewal processing was delayed more than a month when a lead worker mistakenly required Letters of the Estate for a […] Read more

DHA Case No. FCP 214983 (Wis. Div. Hearings and Appeals Jan. 24, 2025) (DHS) ↓ Download PDF ADRCs must determine functional eligibility as soon as practicable, and no later than 30 days after the request for a functional screen. Similarly, IM agencies must generally determine financial and non-financial eligibility within 30 days of the application. […] Read more

DHA Case No. FCP 213852 (Wis. Div. Hearings and Appeals Sep. 12, 2024) (DHS) ↓ Download PDF Family Care enrollment may only be backdated when the agency has caused a delay after the application date. In this case, the petitioner mistakenly applied for Institutional MA in March and was found eligible before discovering that she […] Read more