DHA Case No. CWA 213089 (Wis. Div. Hearings and Appeals Jul. 2, 2024) (DHS) ↓ Download PDF The agency may deny an application for IRIS during the referral stage if the applicant committed substantiated fraud during a previous enrollment. In this case, the petitioner was previously enrolled in IRIS and the agency had issued a […] Read more

DHA Case No. MDV 40/44764 (Wis. Div. Hearings and Appeals 2001) (DHS) ↓ Download PDF It is generally a divestment to sell real estate for less than its fair market value. In this case, the petitioner sold her duplex on the market for $72,500, less than its tax-assessed value of $95,900. ALJ Joseph Nowick concluded […] Read more

DHA Case No. MDV 70/74428 (Wis. Div. Hearings and Appeals Apr. 18, 2006) (DHS) ↓ Download PDF One exception to the usual divestment rule is if the transfer was not made for the purpose of becoming eligible for Medicaid. In this case, the petitioner’s POA transferred three pieces of real estate to family members before […] Read more

DHA Case No. MDV 13/84361 (Wis. Div. Hearings and Appeals May 21, 2007) (DHS) ↓ Download PDF The purchase of a life estate in another person’s home is a divestment if the payment exceeds the value of the life estate. In this case, the petitioner was an elderly woman who moved into her daughter’s home. […] Read more

DHA Case No. CWA 208558 (Wis. Div. Hearings and Appeals Feb. 26, 2024) (DHS) (proposed 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, […] Read more

DHA Case No. CWA 208558 RHG (Wis. Div. Hearings and Appeals Sep. 5, 2023) (DHS) (decision on rehearing) ↓ Download PDF Participants in IRIS may submit a budget amendment (BA) request to increase their budget to pay for an ongoing need not met within the current budget. In this case, the petitioner submitted a BA […] Read more

DHA Case No. CWA 208558 (Wis. Div. Hearings and Appeals Jul. 26, 2023) (DHS) ↓ Download PDF Participants in the IRIS program have certain rights to appeal that do not extend to providers. In this case, the petitioner appealed the denial of his budget amendment request to increase the rate paid to his supportive home […] Read more

DHA Case No. MGE 175523 (Wis. Div. Hearings and Appeals Mar. 29, 2017) (DHS) (proposed decision on cost motion) ↓ Download PDF A petitioner who wins a contested fair hearing is entitled to costs (including attorney fees) unless the agency was “substantially justified” or special circumstances would make the award unjust. In this case, the […] Read more

DHA Case No. MGE 175523 (Wis. Div. of Hearings and Appeals September 27, 2016) (DHS) ↓ Download PDF Although medical assistance applicants must verify relevant information, an agency cannot deny benefits if the applicant is incapable of obtaining the verification or needs help getting it. In this case, a prior fair hearing had determined that […] Read more

DHA Case No. MGE 157892 (Wis. Div. of Hearings and Appeals July 30, 2014) (DHS) ↓ Download PDF County agencies may not over-verify; they may only require the verification needed to determine eligibility. In this case, the agency requested verification of an old family trust that had been depleted and the value of a Wispact […] Read more

DHA Case No. CWA 212224 (Wis. Div. of Hearings and Appeals July 3, 2024) (DHS) ↓ Download PDF Family Care enrollment may be backdated if agency error causes a delay in enrollment. In this case, the ADRC completed the functional screen on October 31 but did not notify IM of the referral until January 10. […] Read more

DHA Case No. MGE 212813 (Wis. Div. of Hearings and Appeals June 28, 2024) (DHS) ↓ Download PDF Family Care enrollment may be backdated if agency error causes a delay in enrollment. In this case, the agency requested verification of a new funeral trust—which the petitioner had created but not reported during the pandemic—during a […] Read more

DHA Case No. MLL 212171 (Wis. Div. of Hearings and Appeals July 9, 2024) (DHS) ↓ Download PDF When estate recovery makes a claim, Wisconsin law gives a right to appeal the issues of the value of the property and the extent of the decedent’s interest in it. In this case, the petitioner and the […] Read more

DHA Case No. MGE 213476 (Wis. Div. of Hearings and Appeals July 8, 2024) (DHS) ↓ Download PDF The county agency must give individuals adequate written notice of verification requests. In this case, the requests “became numerous and internally inconsistent,” confusing the petitioner. ALJ Kenneth Duren concluded the agency failed to follow proper verification procedures […] Read more