3 Financial Eligibility

DHA Case No. MDV-45/86382 (Wis. Div. of Hearings and Appeals November 19, 2007) (DHS)  ↓ Download PDF Issue 1: Caretaker child The caretaker child exception allows an institutionalized person to transfer homestead property to a child who lived with the person and provided care for at least two years. In this case, the petitioner co-owned […] Read more

DHA Case No. MDV-37/88496 (Wis. Div. of Hearings and Appeals May 16, 2008) (DHS)  ↓ Download PDF Promissory notes are commonly used to reduce countable resources for Medicaid eligibility. The rules require the note to have a repayment term within the applicant’s life expectancy, require equal payments with no balloon payment, prohibit cancellation of the […] Read more

DHA Case No. MRA 135337 (Wis. Div. of Hearings and Appeals Feb. 10, 2012) (DHS)  ↓ Download PDF The Medicaid Eligibility Handbook contains two apparently conflicting rules. On the one hand, revocable annuities are counted as available assets. On the other hand, the retirement accounts of a community spouse are exempt. In this case, the […] Read more

DHA Case No. MRA-70/110322 (Wis. Div. of Hearings and Appeals May 19, 2010) (DHS)  ↓ Download PDF This case is an example of using the fair hearing process to increase the Community Spouse Resource Allowance (CSRA) beyond the normal limits. At the time of this case, the maximum CSRA would have been something like $110,000. […] Read more

DHA Case No. MGE 117071 (Wis. Div. of Hearings and Appeals Jul. 26, 2011) (DHS)  ↓ Download PDF This case is one example of a marital property agreement avoiding the potential divestment when a community spouse (1) dies, (2) leaves property to someone other than the institutionalized spouse, and (3) the institutionalized spouse fails to […] Read more

DHA Case No. MDV 144813 (Wis. Div. of Hearings and Appeals Jan. 18, 2013) (DHS)  ↓ Download PDF The petitioner in this case spent $195,000 on life-insurance-funded burial contracts (LIFBCs) to become eligible for Medicaid. She bought 13 of them, all for her children and their spouses, at a cost of $15,000 each. The agency […] Read more

DHA Case No. MDV 146580 (Wis. Div. of Hearings and Appeals April 23, 2013) (DHS)  ↓ Download PDF In this divestment case, the petitioner divested $85,000 to relatives. Those same relatives afterward paid about $89,000 for the petitioner’s nursing home care. Despite this, the agency found only a partial cure, arguing that only the payments […] Read more

DHA Case No. MGE 148648 (Wis. Div. of Hearings and Appeals Sep. 4, 2013) (DHS)  ↓ Download PDF In this straightforward case, the issue was simply whether paying a private-rate nursing home bill reduced the petitioner’s countable assets. Unsurprisingly, it did. It appears the issue came up because the county chafed against a well-known fact […] Read more

DHA Case No. FCP 155113 (Wis. Div. of Hearings and Appeals May 14, 2014) (DHS)  ↓ Download PDF The issue in this case was whether overnight caregiver costs counted as a remedial expense, which could be deducted from income before determining the cost share. The agency argued these could not be a remedial expense, relying […] Read more

DHA Case No. MGE 170367 (Wis. Div. of Hearings and Appeals March 2, 2016) (DHS)  ↓ Download PDF This decision discussed two issues at some length. First, whether payments to the petitioner’s daughter were divestments; and second, whether the petitioner’s former home, now rented at fair market value, was countable. On the first issue, the […] Read more

DHA Case No. MGE 160646 (Wis. Div. Hearings and Appeals January 9, 2015) (DHS)  ↓ Download PDF This case involved two main issues: (1) the date the petitioner transferred ownership of a life insurance policy to her Wispact sub-account, and (2) the effect of a pending disability determination on retroactive eligibility. On the first issue, […] Read more

DHA Case No. MGE 185074 (Wis. Div. Hearings and Appeals March 14, 2018) (DHS)  ↓ Download PDF In this straightforward decision, the petitioner owned home property in Michigan but was admitted to a Wisconsin nursing home. Her Medicaid application was denied because the agency “did not receive timely verification of any circumstance that would exempt […] Read more

DHA Case No. MDV 195771 (Wis. Div. Hearings and Appeals January 9, 2020) (DHS)  ↓ Download PDF In this case, the petitioner’s son bought her multi-family residential property, which had also been her home. A bank evaluation estimated the property’s fair market value at $225,000, and the tax assessment bill estimated it at $236,500. The […] Read more

DHA Case No. FCP 193270 (Wis. Div. Hearings and Appeals June 14, 2019) (DHS)  ↓ Download PDF In this case, the petitioner was receiving Family Care and owed monthly room and board to an assisted living facility. Due to an anomaly, the check for December was never delivered, resulting in it being reissued and mailed […] Read more