DHA Case No. FCP 203537 (Wis. Div. of Hearings and Appeals January 28, 2022) (DHS) ↓ Download PDF Dental implants are listed as a non-covered service under Wis. Admin. Code § DHS 107.07(4)(i). In this case, the petitioner had strong evidence that dental implant-retained dentures were medically necessary and would support her long-term care outcomes. […] Read more

DHA Case No. MPA 203721 (Wis. Div. of Hearings and Appeals January 19, 2022) (DHS) ↓ Download PDF To determine the number of approved personal care worker hours, providers use the Personal Care Screening Tool, which can then be adjusted. In this case, the petitioner asked for 29.75 hours per week but was only approved […] Read more

DHA Case No. HMO 203704 (Wis. Div. of Hearings and Appeals January 25, 2022) (DHS) ↓ Download PDF A power wheelchair must be approved as medically necessary before Medicaid will pay for it, a determination that includes factors such as being not duplicative of other services and being cost-effective compared to alternatives. In this case, […] Read more

DHA Case No. MGE 203510 (Wis. Div. of Hearings and Appeals March 9, 2022) (DHS) ↓ Download PDF Income is not available if the individual lacks the legal ability to make it available for support and maintenance. In this case, the petitioner was on hospice and totally incapacitated, had no POA or guardian, her marital […] Read more

DHA Case No. FCP 205395 (Wis. Div. of Hearings and Appeals August 16, 2022) (DHS) ↓ Download PDF If agency error causes an unreasonable delay in an individual’s enrollment in Family Care, DHS may backdate enrollment. In this case, the petitioner applied for Community Waivers for both spouses on April 20, but enrollment did not […] Read more

DHA Case No. MOP 204371 (Wis. Div. of Hearings and Appeals May 2, 2022) (DHS) ↓ Download PDF A person must be a resident of Wisconsin to receive Medicaid benefits, and residency ends if another state determines the person to be a resident for its own Medicaid programs. In this case, the petitioner applied for […] Read more

DHA Case No. MAC 205887 (Wis. Div. of Hearings and Appeals December 29, 2022) (DHS) ↓ Download PDF A mailed hearing request is considered filed on the date of the postmark or the date DHA actually receives it, whichever is earlier. In this case, the petitioner mailed the request, but there was no postmark and […] Read more

DHA Case No. FCP 197076 (Wis. Div. Hearings and Appeals Feb. 28, 2020) (DHS)  ↓ Download PDF In this case, the petitioner had a life estate in two properties, one in California and one in Wisconsin. Both were rented. But Dane County DHS did not reduce the petitioner’s cost share to allow her to pay […] Read more

DHA Case No. MED 67/53178 (Wis. Div. Hearings and Appeals Feb. 28, 2003) (DHS)  ↓ Download PDF In this case, a Medicaid recipient failed to report a divestment that occurred after her initial application was approved and benefits had started. The ALJ held that, despite the failure to report, the overpayment of benefits was not […] Read more

DHA Case No. MGE 174654 (Wis. Div. Hearings and Appeals July 27, 2016) (DHS)  ↓ Download PDF In this case, the county required a full five years of financial documentation because “there were a few discrepancies” in the initial documents provided. The applicant complied with more than 600 pages of documentation, plus authorizations for the […] Read more