DHA Case No. MRA 211198 (Wis. Div. of Hearings and Appeals March 28, 2024) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” In this case, the community spouse was diagnosed […] Read more

DHA Case No. MGE 211383 (Wis. Div. of Hearings and Appeals March 28, 2024) (DHS) ↓ Download PDF The patient liability for an institutionalized person generally leaves only a small amount of money for personal needs ($45 at the time of this case, now $55). In this case, the petitioner complained that her $45 per […] Read more

DHA Case No. MGE 211311 (Wis. Div. of Hearings and Appeals March 19, 2024) (DHS) ↓ Download PDF Tribal General Welfare Assistance (GWA) is exempt income only if it is based on the individual’s demonstration of need. In this case, the petitioner received GWA that was apparently not based on need. ALJ Teresa Perez concluded […] Read more

DHA Case No. MGE 211566 (Wis. Div. of Hearings and Appeals March 15, 2024) (DHS) ↓ Download PDF Countable assets do not include income received that month and money that is not available. In this case, the petitioner’s eligibility for July was denied because the agency counted $1,599 in Social Security (deposited July 3) and […] Read more

DHA Case No. MRA 210683 (Wis. Div. of Hearings and Appeals January 8, 2024) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” In this case, the community spouse had many […] Read more

DHA Case No. MGE 169735 (Wis. Div. of Hearings and Appeals May 3, 2016) (DHS) ↓ Download PDF Applicants for Medicaid must verify their assets, but workers cannot deny eligibility if the applicant lacks the ability to produce verification. In this case, the petitioner was incompetent and her representatives—her son and lawyer—were unable to verify […] Read more

DHA Case No. MGE 162960 (Wis. Div. of Hearings and Appeals March 6, 2015) (DHS) ↓ Download PDF In a spousal impoverishment case, any assets designated for burial purposes are exempt (as long as the amount is reasonable). In this case, the petitioner designated stocks and an insurance policy as burial funds on his November […] Read more

DHA Case No. MGE 175387 (Wis. Div. of Hearings and Appeals September 27, 2016) (DHS) ↓ Download PDF For Institutional Long-Term Care Medicaid, an applicant is income-eligible if they are categorically needy or medically needy. An applicant is medically needy if his or her income does not exceed his or her monthly need, the biggest […] Read more

DHA Case No. MED 14/72307 (Wis. Div. of Hearings and Appeals March 17, 2006) (DHS) ↓ Download PDF Institutionalized MA recipients must pay their income towards their cost of care, but are allowed a deduction to pay for medical expenses not covered by MA. In this case, the petitioner owed the nursing home $3,500 for […] Read more

DHA Case No. MDV 40/54978 (Wis. Div. of Hearings and Appeals December 5, 2002) (DHS) ↓ Download PDF An institutionalized person may transfer homestead property to their child if the child lived with them and provided care keeping them out of an institution for at least two years immediately before becoming institutionalized. In this case, […] Read more

DHA Case No. MDV 49/44514 (Wis. Div. of Hearings and Appeals June 19, 2000) (DHS) ↓ Download PDF To qualify for the caretaker child exception to divestment, the child must “reside in” the institutionalized person’s home in addition to taking care of them. In this case, the petitioner’s son lived in his own, separately-taxed mobile […] Read more

DHA Case No. MED 53/97033 (Wis. Div. of Hearings and Appeals December 8, 2008) (DHS) ↓ Download PDF Home maintenance expenses only reduce the patient liability of an institutionalized recipient if a physician certifies the recipient is likely to return home within six months. In this case, the physician certified that the petitioner was not […] Read more

DHA Case No. MRA 70/105086 (Wis. Div. of Hearings and Appeals July 30, 2009) (DHS) ↓ Download PDF In general, an asset is counted if it is available—if the owner can access it and use it for support and maintenance. In this case, the agency counted as available a $7,233 check paid to and cashed […] Read more

DHA Case No. MGE 211422 (Wis. Div. of Hearings and Appeals February 1, 2024) (DHS) ↓ Download PDF A life-insurance funded burial contract (LIFBC or “burial insurance”) can be funded with more than $4,500 and still be exempt for Medicaid eligibility; but an irrevocable funeral trust can only make up to $4,500 truly irrevocable and […] Read more