DHA Case No. FCP 219488 (Wis. Div. Hearings and Appeals Nov. 4, 2025) (DHS) ↓ Download PDF To be covered under Family Care, a service must be cost-effective. In this case, the MCO denied the petitioner’s request for 24/7 supportive home care (SHC), claiming it would be more cost-effective for him to move to a […] Read more

DHA Case No. CWA 219979 (Wis. Div. Hearings and Appeals Oct. 27, 2025) (DHS) ↓ Download PDF To be eligible for Community Waivers programs, a person must be in one of the target groups—physical disability, frail elder, or developmental disability—in addition to needing a nursing home level of care. In this case, the 21-year-old petitioner […] Read more

DHA Case No. MDD 219938 (Wis. Div. Hearings and Appeals Oct. 23, 2025) (DHS) ↓ Download PDF The MAPP program allows disabled individuals to work but to retain eligibility for MA. In this case, the petitioner lost his SSI and “regular” MA when a new job put him over the substantial gainful activity limit, but […] Read more

DHA Case No. CWA 219333 (Wis. Div. Hearings and Appeals Oct. 15, 2025) (DHS) ↓ Download PDF Aperson enrolled in IRIS is required to pay a cost share as a condition of eligibility. In this case, the petitioner had more than $4,000 in overdue cost share and had previously entered a repayment agreement, but failed […] Read more

DHA Case No. CWA 219663 (Wis. Div. Hearings and Appeals Oct. 13, 2025) (DHS) ↓ Download PDF An IRIS participant may be involuntarily disenrolled if the program cannot ensure the participant’s health and safety. In this case, the petitioner had 25 critical incidents (a critical incident is a medical emergency, law enforcement contact, or hospitalization) […] Read more

DHA Case No. MGE 219014 (Wis. Div. Hearings and Appeals Oct. 6, 2025) (DHS) ↓ Download PDF IRIS enrollment dates may be revised if the agency is the cause of a wrongful termination of IRIS enrollment. In this case, the agency sent advance notice of the renewal deadline and a notice requiring verification of a […] Read more

DHA Case No. CWA 219176 (Wis. Div. Hearings and Appeals Oct. 1, 2025) (DHS) ↓ Download PDF IRIS enrollment dates may be revised if the agency is the cause of a wrongful termination of IRIS enrollment. In this case, the agency called the petitioner before her renewal deadline but she declined to do the renewal […] Read more

DHA Case No. CWA 218110 (Wis. Div. Hearings and Appeals Sep. 25, 2025) (DHS) ↓ Download PDF IRIS participants may submit one-time expense requests to pay for goods or services, including adaptive aids such as vehicle modifications. In this case, the petitioner requested a wheelchair and hand-controls conversion after her old vehicle, which had been […] Read more

DHA Case No. CWA 218862 (Wis. Div. Hearings and Appeals Sep. 19, 2025) (DHS) ↓ Download PDF IRIS participants may be disenrolled if they cannot or will not address health and safety concerns. In this case, the petitioner lived with his parents/guardians who themselves were aging and having health problems that were impeding their ability […] Read more

DHA Case No. CWA 218438 (Wis. Div. Hearings and Appeals Sep. 18, 2025) (DHS) ↓ Download PDF Prevocational services may be funded through IRIS, but services in sheltered workshop settings are excluded and the participant must have a goal of community-integrated employment. In this case, the petitioner received prevocational services for 11 years in a […] Read more

DHA Case No. CWA 219278 (Wis. Div. Hearings and Appeals Sep. 11, 2025) (DHS) ↓ Download PDF Any negative action regarding a person enrolled in Medicaid must be preceded by proper notice. In this case, the petitioner lost her SSI eligibility but the agency never sent a notice before terminating her from IRIS. ALJ Brian […] Read more

DHA Case No. FCP 218531 (Wis. Div. Hearings and Appeals Sep. 4, 2025) (DHS) ↓ Download PDF The Family Care program must generally cover services that reasonably and effectively address the participant’s long-term needs, but those services must also be cost-effective. In this case, the agency denied the petitioner’s request for coverage of a health […] Read more

DHA Case No. FCP 219093 (Wis. Div. Hearings and Appeals Aug. 25, 2025) (DHS) ↓ Download PDF The Family Care program must generally cover services that reasonably and effectively address the participant’s long-term needs, but those services must also be cost-effective. In this case, the petitioner’s home-delivered meals ended because his plan already included Supportive […] Read more

DHA Case No. CWA 219215 (Wis. Div. Hearings and Appeals Aug. 22, 2025) (DHS) ↓ Download PDF Any negative action regarding a person enrolled in Medicaid must be preceded by proper notice that includes appeal rights. In this case, the petitioner lost her SSI eligibility but the agency never sent a notice with appeal rights […] Read more