DHA Case No. FCP 208218 (Wis. Div. of Hearings and Appeals June 12, 2023) (DHS) ↓ Download PDF Cost share reductions are effective the month of the change report, even if the actual change in income or expense was earlier. In this case, the petitioner enrolled in Family Care with a cost share effective November […] 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 203793 (Wis. Div. of Hearings and Appeals December 23, 2021) (DHS) ↓ Download PDF Income is not counted as a resource in the month it is received. In this case, the petitioner had income of $3,660.10, but his checking account balance at the end of the month was only $983.80. The […] Read more

DHA Case No. BCS 207099 (Wis. Div. of Hearings and Appeals February 20, 2023) (DHS) ↓ Download PDF Countable self-employment income is generally reduced by business expenses, but “principal payments on loans for the purchase price of income-producing real estate, capital assets and equipment, and durable goods” are not allowed expenses for BadgerCare Plus and Medicaid. In […] 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. BCS 207395 (Wis. Div. of Hearings and Appeals March 28, 2023) (DHS) ↓ Download PDF A Notice of Proof Needed must advise the applicant of the specific verification required. In this case, the petitioner received a notice requesting proof of “TUITION: Amount of student loan or grant funds and how they are […] Read more

DHA Case No. MGE 196854 (Wis. Div. of Hearings and Appeals February 14, 2020) (DHS) ↓ Download PDF For EBD Medicaid programs, a couple’s income is only counted together if they are legally married and living together. In this case, the petitioner lived with his partner, had children with her, had a commitment ceremony, and […] Read more

DHA Case No. MOP 197486 (Wis. Div. of Hearings and Appeals February 27, 2020) (DHS) ↓ Download PDF To establish an overpayment, the Department has the burden of proof by the preponderance of the evidence. In this case, the issue was whether the petitioner’s husband lived with her or not (if so, her household income […] Read more

DHA Case No. CWA 198273 (Wis. Div. of Hearings and Appeals August 3, 2020) (DHS) ↓ Download PDF This brief decision is a straightforward application of the name-on-the-check rule. A Medicaid-compliant annuity that pays only to the community spouse is not income available to the insititutionalized spouse. Preliminary Recitals Pursuant to a petition filed on […] Read more

DHA Case No. MGE 200475 (Wis. Div. of Hearings and Appeals February 8, 2021) (DHS) ↓ Download PDF Eligibility for MA begins the first of the month in which the applicant meets all program requirements. In this case, the petitioner planned for a divestment penalty with a Medicaid-compliant annuity, but the final annuity payment occurred […] Read more

DHA Case No. MGE 201844 (Wis. Div. of Hearings and Appeals July 12, 2021) (DHS) ↓ Download PDF In determining patient liability, the Medicaid Eligibility Handbook allows a limited number of deductions from income. In this case, the petitioner could not afford to pay both his patient liability and his bankruptcy settlement. ALJ Kelly Cochrane could find […] Read more

DHA Case No. MGE 203510 (Wis. Div. of Hearings and Appeals March 9, 2022) (DHS) ↓ Download PDF Income is not available if the individual lacks the legal ability to make it available for support and maintenance. In this case, the petitioner was on hospice and totally incapacitated, had no POA or guardian, her marital […] Read more

DHA Case No. BCS 204450 (Wis. Div. of Hearings and Appeals March 29, 2022) (DHS) ↓ Download PDF In general, all taxable gross income is counted when determining eligibility for BadgerCare Plus, including Social Security income. In this case, the petitioner deposited his Social Security into an ABLE account. ALJ Beth Whitaker found that the […] Read more