3 Financial Eligibility

MDV 66/71952 (01/25/2006)
Payments for nursing home care cured divestment

Tags: 3 Financial Eligibility, 3.3 Divestment, 3.3.01 Penalty period, 3.3.05 Ownership returned; cure, 3.3.18 Promissory notes – loans – land contracts – mortgages, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Nancy J. Gagnon

DHA Case No. MDV 66/71952 (Wis. Div. Hearings and Appeals Jan. 25, 2006) (DHS) ↓ Download PDF A divestment penalty may be “cured” by returning the divested resource, or its equivalent value, to the individual. In this case, the petitioner made multiple divestments during the lookback period totaling more than $200,000, but her son paid […] Read more

MDV 149517 (07/26/2013)
Spreadsheet insufficient for verification; income presumed spent on living expenses

Tags: 3 Financial Eligibility, 3.3 Divestment, 3.3.03 Transfers for FMV, 3.3.06 Transfers made for purpose other than to qualify for Medicaid, 3.3.23 Transfer of income in the month of receipt, 4 Program Administration, 4.1 Verification, 4.5 Undue hardship, ALJ Mayumi M. Ishii

DHA Case No. MDV 149517 (Wis. Div. Hearings and Appeals Jul. 26, 2013) (DHS) ↓ Download PDF Money spent for fair market value is generally not a divestment, but the agency may require verification of large cash withdrawals. In this case, the petitioner’s daughter attempted to verify $22,219.40 in cash withdrawals with a spreadsheet. ALJ […] Read more

MDV 147776 (07/12/2013)
No time limit for verification needed to start divestment penalty

Tags: 3 Financial Eligibility, 3.3 Divestment, 3.3.01 Penalty period, 3.3.18 Promissory notes – loans – land contracts – mortgages, 4 Program Administration, 4.1 Verification, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Brian C. Schneider

DHA Case No. MDV 147776 (Wis. Div. Hearings and Appeals Jul. 12, 2013) (DHS) ↓ Download PDF The divestment penalty period for an Institutional MA applicant begins on the first date the person (1) is institutionalized, (2) has applied for Medicaid, and (3) is otherwise eligible for Medicaid. In this case, the petitioner applied on […] Read more

MDV 146016 (03/05/2013)
Community Waivers divestment penalty started without functional screen

Tags: 3 Financial Eligibility, 3.3 Divestment, 3.3.01 Penalty period, 5 Subprograms, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.1 Family Care, ALJ David D. Fleming

DHA Case No. MDV 146016 (Wis. Div. Hearings and Appeals Mar. 5, 2013) (DHS) ↓ Download PDF The divestment penalty period for a Family Care applicant begins on the first date the person (1) has applied for Family Care, (2) “meets the appropriate level of care and functional screen criteria,” and (3) meets all other […] Read more

FCP 140118 (07/13/2012)
$100k spent gambling was divestment due to no verification

Tags: 3 Financial Eligibility, 3.3 Divestment, 3.3.01 Penalty period, 3.3.06 Transfers made for purpose other than to qualify for Medicaid, 3.3.06.3 Pattern of gifting, 3.3.16 Gambling losses, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Kelly Cochrane

DHA Case No. FCP 140118 (Wis. Div. Hearings and Appeals Jul. 13, 2012) (DHS) ↓ Download PDF Adivestment occurs when an institutionalized individual or spouse transfers assets for less than fair market value during the look-back period. In this case, the petitioner’s husband made cash withdrawals of $100,000 and $17,000 shortly before the application for […] Read more

MDV 138459 (04/24/2012)
Unexplained bank withdrawals were divestments

Tags: 3 Financial Eligibility, 3.3 Divestment, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Gary M. Wolkstein

DHA Case No. MDV 138459 (Wis. Div. Hearings and Appeals Apr. 24, 2012) (DHS) ↓ Download PDF A divestment occurs when an institutionalized individual transfers assets for less than fair market value during the look-back period. In this case, the petitioner’s bank statements showed withdrawals of $29,134.50 over two years. Her daughter and POA could […] Read more

MDV 130600 (05/23/2011)
Pattern of gifts over 15% of income were divestments

Tags: 3 Financial Eligibility, 3.3 Divestment, 3.3.01 Penalty period, 3.3.06 Transfers made for purpose other than to qualify for Medicaid, 3.3.06.3 Pattern of gifting, 5 Subprograms, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.1 Family Care, ALJ Marina Croft

DHA Case No. MDV 130600 (Wis. Div. Hearings and Appeals May 23, 2011) (DHS) ↓ Download PDF A transfer of income or resources for less than fair market value is a divestment and results in a penalty period, unless the transfer qualifies for an exception. One exception is if the applicant can show a pattern […] Read more

MDV 55/83139 (05/09/2007)
Land intended for future home was not exempt homestead

Tags: 3 Financial Eligibility, 3.2 Assets, 3.2.7 Real property, 3.2.7.1 Homestead, 3.3 Divestment, ALJ Michael D. O’Brien

DHA Case No. MDV 55/83139 (Wis. Div. Hearings and Appeals May 9, 2007) (DHS) ↓ Download PDF To count as exempt homestead property, the Medicaid applicant must currently live on the property (or have lived there before admission to a facility and intend to return). In this case, the petitioner received $219,000 from a lawsuit […] Read more

MGE 217838 (07/15/2025)
Spousal support payments deducted from Community Waivers income

Tags: 3 Financial Eligibility, 3.1 Income, 3.1.8 Income deductions, 3.1.8.2 Support payments, 3.3 Divestment, 3.3.01 Penalty period, 5 Subprograms, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.1 Family Care, ALJ Kate J. Schilling

DHA Case No. MGE 217838 (Wis. Div. Hearings and Appeals Jul. 15, 2025) (DHS) ↓ Download PDF Court-ordered support payments are deducted from income for an “institutionalized person,” according to the Medicaid Eligibility Handbook (MEH). In this case, the petitioner paid $4,059 per month in court-ordered spousal support, had monthly income of $12,089.20 ($8,045.98 from a […] Read more

MAP 214590 (01/15/2025)
$6,000 cap on income-producing property in MEH rejected, rental property exempt

Tags: 3 Financial Eligibility, 3.2 Assets, 3.2.7 Real property, 3.2.8 Business property, 5 Subprograms, 5.03 Medicaid Purchase Plan, ALJ Kate J. Schilling

DHA Case No. MAP 214590 (Wis. Div. Hearings and Appeals Jan. 15, 2025) (DHS) ↓ Download PDF The Wisconsin Administrative Code exempts non-homestead property if it produces a reasonable amount of income, but the Medicaid Eligibility Handbook limits this exemption to $6,000. In this case, the petitioner owned a single rental home that produced at […] Read more

MGE 212301 (09/16/2024)
Petitioner insisted he owned life insurance, failed to verify

Tags: 3 Financial Eligibility, 3.2 Assets, 3.2.6 Liquid assets, 3.2.6.05 Life insurance, 3.2.6.09 Vehicles, 4 Program Administration, 4.1 Verification, ALJ Jason M. Grace

DHA Case No. MGE 212301 (Wis. Div. Hearings and Appeals Sep. 16, 2024) (DHS) ↓ Download PDF The agency can deny Medicaid when the applicant or recipient is able to produce required verifications but refuses or fails to do so. In this case, the petitioner failed to verify, at his renewal, one of his vehicles, […] Read more

MDV 215995 (02/07/2025)
Landlocked real estate sold for less than tax-estimated value was not divestment

Tags: 3 Financial Eligibility, 3.2.7 Real property, 3.3 Divestment, 3.3.03 Transfers for FMV, 3.3.06 Transfers made for purpose other than to qualify for Medicaid, ALJ John P. Tedesco

DHA Case No. MDV 215995 (Wis. Div. Hearings and Appeals Feb. 7, 2025) (DHS) ↓ Download PDF Selling real estate for less than its fair market value is generally a divestment. In this case, the petitioner sold a real estate parcel to her son for $25,531.69; its estimated fair market value on the tax assessment […] Read more

MRA 215653 (12/20/2024)
CSIA increased for high housing costs, phone, car insurance

Tags: 3 Financial Eligibility, 3.4 Spousal impoverishment, 3.4.6 Community spouse income allocation, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Kelly Cochrane

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

BCS 215161 (12/18/2024)
Unsigned tax return, aggregated income report were insufficient verification of self-employment income

Tags: 3 Financial Eligibility, 3.1 Income, 3.1.7 Self-employment income, 4 Program Administration, 4.1 Verification, 5 Subprograms, 5.15 BadgerCare Plus, ALJ Wendy I. Smith

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

FCP 215902 (02/19/2025)
Burial trust with more than $4,500 was countable, caused gap in benefits

Tags: 3 Financial Eligibility, 3.2 Assets, 3.2.4 Burial assets, 5 Subprograms, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.1 Family Care, 5.05.7 Effective date, ALJ Kate J. Schilling

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

Tag: 3 Financial Eligibility