DHA Case No. CWA 195974 (Wis. Div. of Hearings and Appeals January 6, 2020) (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 petitioner refused […] Read more

DHA Case No. MGE 194293 (Wis. Div. of Hearings and Appeals January 6, 2020) (DHS) ↓ Download PDF The amount a community spouse can keep depends on the couple’s total resources on the date of the asset assessment, which is often the date a functional screen was completed and the person was determined functionally eligible. […] Read more

DHA Case No. FCP 197060 (Wis. Div. of Hearings and Appeals February 10, 2020) (DHS) ↓ Download PDF An individual is functionally eligible for Family Care if he or she needs a “nursing home” level of care, as determined by the functional screen. This level of care includes those who cannot safely or appropriately perform […] Read more

DHA Case No. MGE 197359 (Wis. Div. of Hearings and Appeals March 4, 2020) (DHS) ↓ Download PDF A community spouse must sign the Medicaid application and verify his or her assets unless a denial would result in undue hardship. In this case, the petitioner moved to a separate home from his wife in the […] Read more

DHA Case No. FCP 197394 (Wis. Div. of Hearings and Appeals March 9, 2020) (DHS) ↓ Download PDF Benefits cannot be denied for lack of verification unless the member had adequate notice and the ability to produce the required verification. In this case, the petitioner, an incapacitated woman with dementia, moved to a CBRF. The […] Read more

DHA Case No. MGE 198010 (Wis. Div. of Hearings and Appeals March 27, 2020) (DHS) ↓ Download PDF When a member disenrolls from a managed long-term care program, DHS’s policy is to automatically test for eligibility for non-waivers programs. In this case, the petitioner voluntarily disenrolled from Family Care after moving to a nursing home […] Read more

DHA Case No. MDV 198638 (Wis. Div. of Hearings and Appeals June 29, 2020) (DHS) ↓ Download PDF A divestment penalty for a Medicaid applicant begins on the date the person applies and is “otherwise eligible” but for the divestment; it begins for a member the first of the month after the member receives timely notice. In this case, […] Read more

DHA Case No. FCP 177944 (Wis. Div. of Hearings and Appeals December 13, 2016) (DHS) ↓ Download PDF It is a divestment when a life estate is terminated and the life estate holder is not paid her proportional share. In this case, the petitioner’s life estate was divested when she sold her home and her […] Read more

DHA Case No. MDV 199858 (Wis. Div. of Hearings and Appeals December 4, 2020) (DHS) ↓ Download PDF Divestment is a transfer of non-exempt resources for less than fair market value. This case involved two potential divestments when the petitioner’s house was sold to her daughter and daughter’s boyfriend: (1) the boyfriend was paid $40,534.37 […] Read more

DHA Case No. MDV 200210 (Wis. Div. of Hearings and Appeals January 21, 2021) (DHS) ↓ Download PDF An appeal must be filed within 45 days of an agency action for the ALJ to have jurisdiction to review it. In this case, the petitioner established an irrevocable trust, divested, and applied for Medicaid in May […] Read more

DHA Case No. MDV 201093 (Wis. Div. of Hearings and Appeals March 8, 2021) (DHS) ↓ Download PDF Using an inheritance to buy personal property for fair market value is not a divestment, but the purchases must be verified. In this case, the petitioner inherited $9,633 and claimed to have spent it on a desk, […] Read more

DHA Case No. MGE 202884 (Wis. Div. of Hearings and Appeals November 2, 2021) (DHS) ↓ Download PDF In a spousal impoverishment case, the most valuable vehicle is exempted and all others are counted. In this case, the petitioner’s attorney argued (among other things) that he could elect to exempt the least valuable vehicle for the asset […] Read more

DHA Case No. MDD 203616 (Wis. Div. of Hearings and Appeals January 19, 2022) (DHS) ↓ Download PDF Even if a person cannot engage in any substantial gainful activity, he must still pass a 5-step test to be determined disabled. If he can perform work he has done in the past, Step 4 requires a […] Read more

DHA Case No. FCP 203537 (Wis. Div. of Hearings and Appeals January 28, 2022) (DHS) ↓ Download PDF Dental implants are listed as a non-covered service under Wis. Admin. Code § DHS 107.07(4)(i). In this case, the petitioner had strong evidence that dental implant-retained dentures were medically necessary and would support her long-term care outcomes. […] Read more