DHA Case No. HMO 209818 (Wis. Div. Hearings and Appeals Jan. 11, 2024) (DHS) ↓ Download PDF An experimental or unproven treatment is not covered by MA as medically necessary. In this case, the petitioner’s request for a peripheral nerve stimulator was denied by her Medicaid HMO because it considered the treatment “unproven and not […] Read more
Tag: 5.01 SSI-Related
DHA Case No. MDD 214689 (Wis. Div. Hearings and Appeals Oct. 21, 2024) (DHS) ↓ Download PDF If the Social Security Administration finds an applicant not disabled within twelve months of a state MA application, that determination is binding on the state. In this case, the petitioner applied for SSI, SSDI, and state MA. Because […] Read more
DHA Case No. MGE 211382 (Wis. Div. of Hearings and Appeals February 29, 2024) (DHS) ↓ Download PDF The asset limit for SSI-related Medicaid is $2,000.00. In this case, the petitioner (a realtor) was able to exempt one vehicle, his homestead, and various properties used for self-employment; but the value of a few small, landlocked […] Read more
DHA Case No. MGE 209717 (Wis. Div. of Hearings and Appeals January 5, 2024) (DHS) ↓ Download PDF To be eligible for SSI-related Medicaid, an unmarried individual’s countable assets must be less than $2,000. The individual must also provide the necessary verification. In this case, the petitioner received a VA lump sum payment and was […] Read more
DHA Case No. MED 36/47216 (Wis. Div. of Hearings and Appeals July 24, 2001) (DHS) ↓ Download PDF Wisconsin’s spousal impoverishment law provides that the income of an institutionalized spouse (including a participant in Community Waivers) is not considered available to the community spouse. In this case, DHS had changed its policy so that the […] Read more
DHA Case No. MED 40/68266 (Wis. Div. of Hearings and Appeals June 27, 2005) (DHS) ↓ Download PDF A Medicaid recipient whose income exceeds the “medically needy” income limit must pay a deductible, which can be met by incurring medical expenses. In this case, the petitioner incurred charges for mental health services at the Milwaukee […] Read more
DHA Case No. MPA 207590 (Wis. Div. of Hearings and Appeals April 3, 2023) (DHS) ↓ Download PDF A specialized bed may be provided under the MA program when prescribed by a physician, but it must be cost-effective and not solely for the comfort or convenience of the recipient. In this case, the petitioner was […] Read more
DHA Case No. BCS 207530 (Wis. Div. of Hearings and Appeals April 6, 2023) (DHS) ↓ Download PDF Wisconsin law provides that able-bodied adults who refused to cooperate in establishing the paternity of a child without good cause are ineligible for MA. In this case, the petitioner refused to identify the father of her child […] Read more
DHA Case No. MDD 200680 (Wis. Div. of Hearings and Appeals February 10, 2021) (DHS) ↓ Download PDF In making a disability determination, the Disability Determination Bureau (DDB) applies a 5-step test. Step 5 considers whether the individual can adjust to types of work the individual has not performed in the past, considering his or […] Read more