DHA Case No. MED 36/47216 (Wis. Div. of Hearings and Appeals July 24, 2001) (DHS) ↓ Download PDF Wisconsin’s spousal impoverishment law provides that the income of an institutionalized spouse (including a participant in Community Waivers) is not considered available to the community spouse. In this case, DHS had changed its policy so that the […] Read more
3 Financial Eligibility
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. MDV 50/105459 (Wis. Div. of Hearings and Appeals September 1, 2009) (DHS) ↓ Download PDF A divestment does not make a person ineligible for Medicaid if the resource was transferred exclusively for some purpose other than to become eligible. In this case, the petitioner’s daughter transferred $7,064.85 to herself so she could […] 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. MDV 40/68902 (Wis. Div. of Hearings and Appeals May 18, 2005) (DHS) ↓ Download PDF An institutionalized person may transfer homestead property to their child if the child lived with them and provided care keeping them out of an institution for at least two years immediately before becoming institutionalized. In this case, […] Read more
DHA Case No. MDV 40/54978 (Wis. Div. of Hearings and Appeals December 5, 2002) (DHS) ↓ Download PDF An institutionalized person may transfer homestead property to their child if the child lived with them and provided care keeping them out of an institution for at least two years immediately before becoming institutionalized. In this case, […] Read more
DHA Case No. MDV 49/44514 (Wis. Div. of Hearings and Appeals June 19, 2000) (DHS) ↓ Download PDF To qualify for the caretaker child exception to divestment, the child must “reside in” the institutionalized person’s home in addition to taking care of them. In this case, the petitioner’s son lived in his own, separately-taxed mobile […] 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. MRA 70/105086 (Wis. Div. of Hearings and Appeals July 30, 2009) (DHS) ↓ Download PDF In general, an asset is counted if it is available—if the owner can access it and use it for support and maintenance. In this case, the agency counted as available a $7,233 check paid to and cashed […] Read more
DHA Case No. MED 292938 (Wis. Div. of Hearings and Appeals September 3, 2008) (DHS) ↓ Download PDF Gifts received by a Medicaid recipient must be reported within ten days. In this case, the petitioner was disabled with cancer. Her community held a fundraiser and gave her almost $30,000, which she failed to report. Although […] Read more
DHA Case No. MGE 211422 (Wis. Div. of Hearings and Appeals February 1, 2024) (DHS) ↓ Download PDF A life-insurance funded burial contract (LIFBC or “burial insurance”) can be funded with more than $4,500 and still be exempt for Medicaid eligibility; but an irrevocable funeral trust can only make up to $4,500 truly irrevocable and […] Read more
DHA Case No. MGE 210403 (Wis. Div. of Hearings and Appeals December 8, 2023) (DHS) ↓ Download PDF The assets in an irrevocable trust funded with the petitioner’s property are potentially available if there are any circumstances allowing payment from the trust to the petitioner. In this case, the petitioner established a Hedlund-type trust in 1996 […] Read more