5.04 Institutional Long-Term Care

DHA Case No. MGE 201120 (Wis. Div. of Hearings and Appeals April 29, 2021) (DHS) ↓ Download PDF When a Medicaid applicant is the grantor of a trust—even an irrevocable trust—it is countable and available “if there are any circumstances under which payment from the trust could be made to or for the benefit of […] Read more

DHA Case No. MGE 198872 (Wis. Div. of Hearings and Appeals August 12, 2020) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook allows business property to be exempted—regardless of value or rate of return—if the individual is “actively involved in the business operation on a day-to-day basis.” Rental property is not exempt unless the owner is in […] Read more

DHA Case No. MGE 208281 (Wis. Div. of Hearings and Appeals May 30, 2023) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook contains two main ways to exempt “property essential to self-support.” The property is (1) exempt (regardless of value or rate of return) if used in a business in which the individual is actively […] Read more

DHA Case No. MRA 178406 (Wis. Div. of Hearings and Appeals January 13, 2017) (DHS) ↓ Download PDF The Medicaid Eligibility Handbook contains two competing rules: revocable annuities are countable and available assets, but IRAs belonging to a community spouse are disregarded. In this case, the community spouse owned an Individual Retirement Annuity, funded by […] Read more

DHA Case No. MED-40/46891 (Wis. Div. of Hearings and Appeals March 29, 2001) (DHS)  ↓ Download PDF In a spousal impoverishment case, the Wisconsin administrative code provides that funds “expressly set aside” for burial expenses are not countable. In this case, the petitioner’s attorney told the county agency, in writing, that $3,000 in a certain […] Read more

DHA Case No. MDV 206205 (Wis. Div. of Hearings and Appeals December 2, 2022) (DHS)  ↓ Download PDF Issue 1: “Irrevocable assignment” The Medicaid Eligibility Handbook provides that an asset is available when the owner can dispose of it, has a legal right to its value, has the legal ability to make it available, and can make […] Read more

DHA Case No. MDV-45/86382 (Wis. Div. of Hearings and Appeals November 19, 2007) (DHS)  ↓ Download PDF Issue 1: Caretaker child The caretaker child exception allows an institutionalized person to transfer homestead property to a child who lived with the person and provided care for at least two years. In this case, the petitioner co-owned […] Read more

DHA Case No. MDV-37/88496 (Wis. Div. of Hearings and Appeals May 16, 2008) (DHS)  ↓ Download PDF Promissory notes are commonly used to reduce countable resources for Medicaid eligibility. The rules require the note to have a repayment term within the applicant’s life expectancy, require equal payments with no balloon payment, prohibit cancellation of the […] Read more

DHA Case No. MRA 135337 (Wis. Div. of Hearings and Appeals Feb. 10, 2012) (DHS)  ↓ Download PDF The Medicaid Eligibility Handbook contains two apparently conflicting rules. On the one hand, revocable annuities are counted as available assets. On the other hand, the retirement accounts of a community spouse are exempt. In this case, the […] Read more

DHA Case No. MRA-70/110322 (Wis. Div. of Hearings and Appeals May 19, 2010) (DHS)  ↓ Download PDF This case is an example of using the fair hearing process to increase the Community Spouse Resource Allowance (CSRA) beyond the normal limits. At the time of this case, the maximum CSRA would have been something like $110,000. […] Read more

DHA Case No. MGE 117071 (Wis. Div. of Hearings and Appeals Jul. 26, 2011) (DHS)  ↓ Download PDF This case is one example of a marital property agreement avoiding the potential divestment when a community spouse (1) dies, (2) leaves property to someone other than the institutionalized spouse, and (3) the institutionalized spouse fails to […] Read more

DHA Case No. MDV 146580 (Wis. Div. of Hearings and Appeals April 23, 2013) (DHS)  ↓ Download PDF In this divestment case, the petitioner divested $85,000 to relatives. Those same relatives afterward paid about $89,000 for the petitioner’s nursing home care. Despite this, the agency found only a partial cure, arguing that only the payments […] Read more

DHA Case No. MGE 148648 (Wis. Div. of Hearings and Appeals Sep. 4, 2013) (DHS)  ↓ Download PDF In this straightforward case, the issue was simply whether paying a private-rate nursing home bill reduced the petitioner’s countable assets. Unsurprisingly, it did. It appears the issue came up because the county chafed against a well-known fact […] Read more

DHA Case No. MGE 170367 (Wis. Div. of Hearings and Appeals March 2, 2016) (DHS)  ↓ Download PDF This decision discussed two issues at some length. First, whether payments to the petitioner’s daughter were divestments; and second, whether the petitioner’s former home, now rented at fair market value, was countable. On the first issue, the […] Read more