DHA Case No. MAP 212440 (Wis. Div. of Hearings and Appeals April 16, 2024) (DHS) ↓ Download PDF Applicants for Medicaid are given at least 20 days from the date of a request to provide verification, and benefits may only be denied if the applicant has the power to produce the verification. In this case, […] Read more
Tag: 5.03 Medicaid Purchase Plan
DHA Case No. MAP 211814 (Wis. Div. of Hearings and Appeals April 8, 2024) (DHS) ↓ Download PDF A trust is not an available asset if it was funded by a third party and the Medicaid applicant or member cannot, by the terms of the trust, require the trustee to make distributions. In this case, […] Read more
DHA Case No. MAP 212141 (Wis. Div. of Hearings and Appeals March 27, 2024) (DHS) ↓ Download PDF An asset is considered unavailable if the owner documents that it will not be available for 30 days or more and a process has been started to obtain the assets. In this case, the petitioner could access […] Read more
DHA Case No. MAP 211494 (Wis. Div. of Hearings and Appeals March 6, 2024) (DHS) ↓ Download PDF To be exempt homestead property, the property must serve as the individual’s primary place of residence. In this case, the petitioner owned real estate worth $25,000 and claimed he lived there in a tent, providing documents and […] Read more
DHA Case No. MGE 209343 (Wis. Div. of Hearings and Appeals October 2, 2023) (DHS) ↓ Download PDF The balance of a land contract is counted as an available asset unless its terms prohibit transfer or no one is willing to purchase it. In this case, the petitioner was selling non-homestead real estate under a […] Read more
DHA Case No. FCP 206604 (Wis. Div. of Hearings and Appeals January 5, 2023) (DHS) ↓ Download PDF Family Care members in Group A (due to eligibility for MAPP, for example) do not have a cost share. In this complex case, the petitioner lost MAPP eligibility when her child turned 18 and her fiscal test […] Read more
DHA Case No. MQB 209568 (Wis. Div. of Hearings and Appeals October 2, 2023) (DHS) ↓ Download PDF With the Public Health Emergency unwinding, members may voluntarily complete an early renewal, but Income Maintenance agencies must inform members that their eligibility may be impacted by doing an early renewal. In this case, the member’s renewal […] Read more
DHA Case No. MDD 207614 (Wis. Div. of Hearings and Appeals April 24, 2023) (DHS) ↓ Download PDF To be eligible for the MAPP program, the applicant must meet the SSI definition of disability. This disability determination considers the applicant’s functional capacity to do various kinds of work. In this case, the applicant was 30 […] Read more
DHA Case No. MDD 207161 (Wis. Div. of Hearings and Appeals March 27, 2023) (DHS) ↓ Download PDF A disability determination for the MAPP does not involve the usual “substantial gainful activity” test, but that is only the first step in a 5-step analysis that often comes down to “residual functional capacity” to perform different […] Read more
DHA Case No. MDD 206834 (Wis. Div. of Hearings and Appeals March 28, 2023) (DHS) ↓ Download PDF To be eligible for MAPP, an applicant must meet the SSI definition of disability. In this case, the petitioner was a 64-year-old woman with a high school diploma; diagnoses including Bipolar Disorder, ADHD, PTSD, torn rotator cuff, […] Read more
DHA Case No. MAP 196477 (Wis. Div. of Hearings and Appeals January 13, 2020) (DHS) ↓ Download PDF To be eligible for the MAPP program, the individual’s countable assets must be below $15,000. Assets titled solely in a spouse’s name do not count for MAPP. In this case, the Department disenrolled the petitioner, apparently counting […] Read more
DHA Case No. MAP 199545 (Wis. Div. of Hearings and Appeals December 17, 2020) (DHS) ↓ Download PDF Medicaid applicants must have adequate notice of the proof needed to verify their assets. In this case, the agency issued a Notice of Proof Needed after finding additional accounts in the Asset Verification System (AVS), but the […] Read more