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

DHA Case No. MGE 212097 (Wis. Div. of Hearings and Appeals May 6, 2024) (DHS) ↓ Download PDF When there is a change in anticipated self-employment earnings, the MEH generally requires the agency to average the most recent months of earnings that reflect the changed circumstances. In this case, the petitioner had royalty income from […] 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

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. 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. CWA 211081 (Wis. Div. of Hearings and Appeals February 8, 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 admittedly not based on need. ALJ Peter McCombs concluded […] 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. MGE 175387 (Wis. Div. of Hearings and Appeals September 27, 2016) (DHS) ↓ Download PDF For Institutional Long-Term Care Medicaid, an applicant is income-eligible if they are categorically needy or medically needy. An applicant is medically needy if his or her income does not exceed his or her monthly need, the biggest […] 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. BCS 210387 (Wis. Div. of Hearings and Appeals January 12, 2024) (DHS) ↓ Download PDF In general, BadgerCare Plus counts all taxable income. However, the IRS allows some live-in care providers to list all payments as a business expense; in those circumstances, BadgerCare Plus also does not count these payments as income. […] Read more

DHA Case No. BCS 210493 (Wis. Div. of Hearings and Appeals January 9, 2024) (DHS) ↓ Download PDF BadgerCare Plus eligibility is based on income and, unlike EBD Medicaid programs, taxable withdrawals from IRAs are counted as income. In this case, the petitioner was 63 and his only income was monthly withdrawals of $3,200 from […] Read more

DHA Case No. MED 53/97033 (Wis. Div. of Hearings and Appeals December 8, 2008) (DHS) ↓ Download PDF Home maintenance expenses only reduce the patient liability of an institutionalized recipient if a physician certifies the recipient is likely to return home within six months. In this case, the physician certified that the petitioner was not […] 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