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 212224 (Wis. Div. of Hearings and Appeals July 3, 2024) (DHS) ↓ Download PDF Family Care enrollment may be backdated if agency error causes a delay in enrollment. In this case, the ADRC completed the functional screen on October 31 but did not notify IM of the referral until January 10. […] 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. MGE 212813 (Wis. Div. of Hearings and Appeals June 28, 2024) (DHS) ↓ Download PDF Family Care enrollment may be backdated if agency error causes a delay in enrollment. In this case, the agency requested verification of a new funeral trust—which the petitioner had created but not reported during the pandemic—during a […] Read more

DHA Case No. CWA 213069 (Wis. Div. of Hearings and Appeals June 28, 2024) (DHS) ↓ Download PDF Family Care enrollment may be backdated if agency error causes a delay in enrollment, but only back to the first date the person was determined functionally eligible, was determined MA eligible, and had signed the enrollment form. […] Read more

DHA Case No. FCP 213209 (Wis. Div. of Hearings and Appeals June 27, 2024) (DHS) ↓ Download PDF A Family Care member can be involuntarily disenrolled if they lose or are determined ineligible for MA. In this case, the petitioner was disenrolled when the agency failed to test her for Community Waivers eligibility while processing […] 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. MGE 213356 (Wis. Div. of Hearings and Appeals June 20, 2024) (DHS) ↓ Download PDF In this very brief—but slightly horrifying—case, Milwaukee Enrollment Services notified the petitioner that she was no longer eligible for Community Waivers because “you have asked us to stop giving you this benefit.” This was an undisputed error. […] 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. CWA 212568 (Wis. Div. of Hearings and Appeals June 6, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the petitioner was determined functionally and financially eligible as of December 14, but Income Maintenance simply failed […] Read more