DHA Case No. MRA 215653 (Wis. Div. Hearings and Appeals Dec. 20, 2024) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” In this case, ALJ Kelly Cochrane summarily ordered the […] Read more

DHA Case No. BCS 215161 (Wis. Div. Hearings and Appeals Dec. 18, 2024) (DHS) ↓ Download PDF To be eligible for BadgerCare Plus, a person must meet certain financial and non-financial requirements, including verification of income for self-employment. In this case, the petitioner verified her self-employment income with a partial, unsigned copy of her tax […] Read more

DHA Case No. FCP 215902 (Wis. Div. Hearings and Appeals Feb. 19, 2025) (DHS) ↓ Download PDF An irrevocable burial trust (as opposed to a life insurance-funded burial contract) is exempt up to $4,500; any amount over that is countable. In this case, the petitioner was disenrolled from Family Care due to his $8,800 irrevocable […] Read more

DHA Case No. MGE 173712 (Wis. Div. Hearings and Appeals Sep. 7, 2016) (DHS) ↓ Download PDF To be income-eligible for Institutional MA, an applicant must qualify as either categorically needy (having a very low income) or medically needy, having income less than her monthly need—of which the cost of the nursing home is a […] Read more

DHA Case No. MGE 208717 (Wis. Div. Hearings and Appeals Nov. 26, 2024) (DHS) (decision on cost motion) ↓ Download PDF Under the Wisconsin Equal Access to Justice Act (WEAJA), petitioners who prevail in a fair hearing are entitled to an award of costs unless the agency’s action was “substantially justified.” In this case, the […] Read more

DHA Case No. MDV 214223 (Wis. Div. Hearings and Appeals Nov. 27, 2024) (DHS) ↓ Download PDF A divestment penalty is generally imposed when an applicant reports a divestment and would be otherwise eligible. In this case, the petitioner originally applied in 2020 after creating an irrevocable trust, but no divestment penalty was imposed because […] Read more

DHA Case No. MDV 214942 (Wis. Div. Hearings and Appeals Nov. 20, 2024) (DHS) ↓ Download PDF The deadline to file an appeal of a denied Medicaid application is 45 days from the notice. If a separate undue harship waiver is requested, the petitioner has 20 days from the request to provide any additional proof […] Read more

DHA Case No. MGE 214870 (Wis. Div. Hearings and Appeals Nov. 19, 2024) (DHS) ↓ Download PDF One exception to the usual divestment rule is if the individual intended to dispose of the resource at fair market value. In this case, the petitioner’s husband had “invested” $275,000 in an online scam, for which the county […] Read more

DHA Case No. MGE 215065 (Wis. Div. Hearings and Appeals Nov. 1, 2024) (DHS) ↓ Download PDF For a single person, up to $1,500 can be exempted as a “burial fund” to the extent other exempt burial assets (burial trusts, life-insurance funded burial contracts, exempt life insurance policies, and burial insurance) do not exceed that […] Read more

DHA Case No. BCS 211404 (Wis. Div. Hearings and Appeals Feb. 8, 2024) (DHS) ↓ Download PDF BadgerCare Plus counts all available income, even if the member chooses not to receive it. In this case, the petitioner chose to stop receiving long-term disability benefits of nearly $2,000 per month in an attempt to maintain her […] Read more

DHA Case No. MDV 214370 (Wis. Div. Hearings and Appeals Oct. 22, 2024) (DHS) ↓ Download PDF The transfer of an exempt asset (except a homestead) is not a divestment. In this case, the petitioner bought a car—though she could not drive herself—that her son used to transport her to medical appointments. About seven months […] Read more

DHA Case No. MRA 213346 (Wis. Div. Hearings and Appeals Aug. 30, 2024) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” In this case, ALJ Nicole Bjork increased the CSIA […] Read more

DHA Case No. BCS 213610 (Wis. Div. Hearings and Appeals Sep. 23, 2024) (DHS) ↓ Download PDF To determine self-employment income, Wisconsin Medicaid programs generally use the previous year’s federal tax return; but if the business had a “significant change in circumstances,” the agency must use anticipated earnings instead. In this case, the petitioner was […] Read more

DHA Case No. MRA 213308 (Wis. Div. Hearings and Appeals Jul. 31, 2024) (DHS) ↓ Download PDF A Community Waivers member in Group B or B Plus may use spousal improverishment rules to give income to his or her spouse as an “institutionalized person,” but Group A members are excluded from that definition. In this […] Read more