DHA Case No. MGE 207999 (Wis. Div. of Hearings and Appeals May 10, 2023) (DHS) ↓ Download PDF When a consumer is discharged from the Comprehensive Community Services (CCS) program and receives MA, they must first exhaust the grievance procedure at the local level before appealing to a fair hearing. The notice of discharge, however, […] Read more

DHA Case No. FCP 210574 (Wis. Div. of Hearings and Appeals November 30, 2023) (DHS) ↓ Download PDF An MCO must give ten days’ notice of any adverse benefit determination. In this case, the petitioner’s MCO issued a notice on September 29 disenrolling her retroactive to August 21. ALJ Brian Schneider concluded the MCO had not […] Read more

DHA Case No. SSO 209011 (Wis. Div. of Hearings and Appeals September 18, 2023) (DHS) ↓ Download PDF DHS cannot recover state SSI benefits that were incorrectly paid more than 12 months before the “date of discovery” of the overpayment. In this case, the Social Security Administration retroactively terminated the petitioner’s SSI eligibility for January […] Read more

DHA Case No. MLL 209431 (Wis. Div. of Hearings and Appeals August 28, 2023) (DHS) ↓ Download PDF An applicant for a hardship waiver of estate recovery must file his or her application within 45 days of estate recovery’s claim, after which the applicant has 60 days to submit additional information. And if the applicant […] Read more

DHA Case No. MGE 210257 (Wis. Div. of Hearings and Appeals December 7, 2023) (DHS) ↓ Download PDF An appeal must be filed within 45 days of a Medicaid application denial for the Division of Hearings and Appeals to have jurisdiction. In this case, the deadline to appeal the initial denial of the Medicaid application […] Read more

DHA Case No. CWA 208908 (Wis. Div. of Hearings and Appeals October 27, 2023) (DHS) ↓ Download PDF In this brief case, the petitioner appealed the termination of her IRIS benefits due to losing functional eligibility. Because she did not appear at the hearing, ALJ John Tedesco dismissed the case and the IRIS termination was […] Read more

DHA Case No. MLL 210337 (Wis. Div. of Hearings and Appeals December 11, 2023) (DHS) ↓ Download PDF One way to get an undue hardship waiver of estate recovery is to show that the decedent’s real property is used as part of the waiver applicant’s business and recovery would take away the applicant’s livelihood. In […] Read more

DHA Case No. CWA 198542 (Wis. Div. of Hearings and Appeals July 21, 2020) (DHS) ↓ Download PDF The IRIS program can pay for home modifications that address “disability related long-term care needs that increase self-reliance and independence, or ensure safe, accessible means of ingress/egress to a participant’s living quarters, or otherwise provide safe access […] Read more

DHA Case No. CWA 205245 (Wis. Div. of Hearings and Appeals September 12, 2022) (DHS) ↓ Download PDF IRIS participants may hire their own workers to provide supportive home care (SHC). The participant is responsible for negotiating “reasonable and customary rates” with providers. In this case, the petitioner asked to increase her worker’s hourly rate […] Read more

DHA Case No. CWK 209490 (Wis. Div. of Hearings and Appeals September 15, 2023) (DHS) ↓ Download PDF The CLTS program can cover “Health and Wellness” services to maintain or improve the health, well being, socialization, or inclusion of the participant with family and peers in the community. But these services must not be duplicative […] Read more

DHA Case No. CWK 207740 (Wis. Div. of Hearings and Appeals June 9, 2023) (DHS) ↓ Download PDF One of the benefits of the Children’s Long-Term Support program is access to a Support and Service Coordinator (SSC); DHS’s Participant Rights and Responsibilities notice even says, “You have a right to meet with this person as […] Read more

DHA Case No. MGE 207256 (Wis. Div. of Hearings and Appeals April 12, 2023) (DHS) ↓ Download PDF Medicaid applicants are required to verify all countable assets. In this case, the petitioner’s application for MA noted that her spouse sold shares of stock in June and July of 2022. She failed to provide verification of […] Read more

DHA Case No. FCP 206978 (Wis. Div. of Hearings and Appeals April 7, 2023) (DHS) ↓ Download PDF In the Family Care program, the MCO must develop an Individual Service Plan (ISP) that reasonably and effectively addresses the enrollee’s long-term care needs and outcomes and is cost-effective. In this case, Community Care ended the petitioner’s […] Read more

DHA Case No. FCP 203910 (Wis. Div. of Hearings and Appeals March 23, 2023) (DHS) ↓ Download PDF If payments to a relative for services exceed 10% of the maximum CSAS, the MEH requires a notarized agreement. In this case, the petitioner had an agreement to pay her daughters $500 per month, but it was […] Read more