DHA Case No. CWA 210721 (Wis. Div. Hearings and Appeals Jan. 3, 2024) (DHS) ↓ Download PDF The IRIS program can cover home modifications, but they must address the participant’s independence, health, safety, or long-term care needs and be cost effective. In this case, the petitioner made a one-time expense request to pay for a […] Read more

DHA Case No. CWA 213161 (Wis. Div. Hearings and Appeals Oct. 28, 2024) (DHS) ↓ Download PDF The Department must ensure the health and safety of IRIS participants. The IRIS policy manual allows involuntary disenrollment for “health and safety risks that participants are unable or unwilling to resolve.” In this case, the participant was a […] Read more

DHA Case No. CWA 213537 (Wis. Div. Hearings and Appeals Oct. 18, 2024) (DHS) ↓ Download PDF The IRIS Policy Manual requires a notice of action and provides a right to appeal when services are reduced, terminated, or denied. In this case, the petitioner’s care worker failed to timely submit the required documentation to become […] Read more

DHA Case No. CWA 213277 (Wis. Div. Hearings and Appeals Sep. 27, 2024) (DHS) ↓ Download PDF An IRIS participant may be involuntarily disenrolled for mismanagement of employer authority responsibilities. In this case, the petitioner had multiple instances of mismanagement with participant-hired workers, including calling the Fiscal Employer Agency posing as one of her workers, […] Read more

DHA Case No. CWA 213191 (Wis. Div. Hearings and Appeals Jul. 15, 2024) (DHS) ↓ Download PDF Community Waivers members in Groups B and B Plus may use spousal improverishment rules to give income to their spouses, but Group A members may not. In this case, the petitioner was enrolled in Group B in 2019 […] Read more

DHA Case No. CWA 213089 (Wis. Div. Hearings and Appeals Jul. 2, 2024) (DHS) ↓ Download PDF The agency may deny an application for IRIS during the referral stage if the applicant committed substantiated fraud during a previous enrollment. In this case, the petitioner was previously enrolled in IRIS and the agency had issued a […] Read more

DHA Case No. CWA 208558 RHG (Wis. Div. Hearings and Appeals Sep. 5, 2023) (DHS) (decision on rehearing) ↓ Download PDF Participants in IRIS may submit a budget amendment (BA) request to increase their budget to pay for an ongoing need not met within the current budget. In this case, the petitioner submitted a BA […] Read more

DHA Case No. CWA 208558 (Wis. Div. Hearings and Appeals Jul. 26, 2023) (DHS) ↓ Download PDF Participants in the IRIS program have certain rights to appeal that do not extend to providers. In this case, the petitioner appealed the denial of his budget amendment request to increase the rate paid to his supportive home […] Read more

DHA Case No. CWA 211772 (Wis. Div. of Hearings and Appeals July 2, 2024) (DHS) ↓ Download PDF Late renewals can cause a gap in Community Waivers enrollment, though the Department has allowed for an expedited re-enrollment process to minimize this. In this case, however, the petitioner submitted his renewal timely on the due date […] Read more

DHA Case No. CWA 212695 (Wis. Div. of Hearings and Appeals June 24, 2024) (DHS) ↓ Download PDF Continuing enrollment in IRIS requires payment of the cost share. In this case, the petitioner had $1,102.50 of unpaid cost share that she argued was discharged in a bankruptcy court order. ALJ Teresa Perez concluded she lacked […] Read more

DHA Case No. CWA 212780 (Wis. Div. of Hearings and Appeals June 10, 2024) (DHS) ↓ Download PDF When the Department reduces benefits, it has the burden of proof and must at least present a prima facie case for its decision. In this case, the agency reduced services it had previously deemed necessary and appropriate […] Read more

DHA Case No. CWA 212769 (Wis. Div. of Hearings and Appeals June 10, 2024) (DHS) ↓ Download PDF Continuing functional eligibility for the IRIS program is determined by a yearly functional screen. In this case, the petitioner’s yearly screen found that she no longer needed a helper present while bathing, resulting in a loss of […] Read more

DHA Case No. CWA 212112 (Wis. Div. of Hearings and Appeals June 7, 2024) (DHS) ↓ Download PDF IRIS may pay for a vehicle modification as a one-time expense (OTE) request, but it must be cost-effective and all other options for funding must be exhausted first. In this case, the 20-year-old petitioner requested a $102,000 […] Read more

DHA Case No. MGE 211474 (Wis. Div. of Hearings and Appeals May 20, 2024) (DHS) ↓ Download PDF IRIS Consultant Agencies (ICAs) must now help participants maintain MA eligibility, including monitoring and reporting any medical or remedial expenses. In this case, the petitioner had more than $2,000 in privately paid personal care expenses that were […] Read more