DHA Case No. MGE 211474 (Wis. Div. of Hearings and Appeals May 20, 2024) (DHS) ↓ Download PDF IRIS Consultant Agencies (ICAs) must now help participants maintain MA eligibility, including monitoring and reporting any medical or remedial expenses. In this case, the petitioner had more than $2,000 in privately paid personal care expenses that were […] Read more
Tag: 3.1.8.5 Medical and remedial expenses
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
DHA Case No. MGE 162960 (Wis. Div. of Hearings and Appeals March 6, 2015) (DHS) ↓ Download PDF In a spousal impoverishment case, any assets designated for burial purposes are exempt (as long as the amount is reasonable). In this case, the petitioner designated stocks and an insurance policy as burial funds on his November […] Read more
DHA Case No. MED 14/72307 (Wis. Div. of Hearings and Appeals March 17, 2006) (DHS) ↓ Download PDF Institutionalized MA recipients must pay their income towards their cost of care, but are allowed a deduction to pay for medical expenses not covered by MA. In this case, the petitioner owed the nursing home $3,500 for […] Read more
DHA Case No. MGE 210319 (Wis. Div. of Hearings and Appeals October 20, 2023) (DHS) ↓ Download PDF In general, all available assets are counted and counted assets are not reduced by outstanding debt. In this case, the petitioner had excess assets at her renewal and an overpayment claim that was pending but not yet […] Read more
DHA Case No. MGE 208326 (Wis. Div. of Hearings and Appeals July 18, 2023) (DHS) ↓ Download PDF Amember’s patient liability can be reduced to allow payment of medical or remedial expenses that the member “has incurred, is actually paying, and is legally obligated to pay.” In this case, after losing fair hearings on the […] Read more
DHA Case No. MGE 207353 (Wis. Div. of Hearings and Appeals June 21, 2023) (Decision on Remand) (DHS) ↓ Download PDF Amember’s patient liability can be reduced to allow payment of medical or remedial expenses that the member “has incurred, is actually paying, and is legally obligated to pay.” In this case, the petitioner verified […] Read more
DHA Case No. MGE 207580 (Wis. Div. of Hearings and Appeals April 14, 2023) (DHS) ↓ Download PDF An institutionalized spouse may allocate income to the community spouse up to a certain amount, and an ALJ may increase that if the petitioner shows “exceptional circumstances resulting in financial duress.” In this case, the petitioner appealed […] Read more
DHA Case No. MGE 207353 (Wis. Div. of Hearings and Appeals March 28, 2023) (DHS) ↓ Download PDF A member’s patient liability can be reduced to allow payment of medical or remedial expenses that the member “has incurred, is actually paying, and is legally obligated to pay.” In this case, the petitioner verified that he […] Read more
DHA Case No. FCP 155113 (Wis. Div. of Hearings and Appeals May 14, 2014) (DHS) ↓ Download PDF The issue in this case was whether overnight caregiver costs counted as a remedial expense, which could be deducted from income before determining the cost share. The agency argued these could not be a remedial expense, relying […] Read more