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
Tag: 5.05 Home and Community-Based Waivers Long-Term Care
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
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
DHA Case No. FCP 212098 (Wis. Div. of Hearings and Appeals April 26, 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 claimed to have sent verification of assets being below $2,000 in December—via ACCESS and, a […] Read more
DHA Case No. FCP 211909 (Wis. Div. of Hearings and Appeals April 23, 2024) (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. In this case, the petitioner’s functional screen found the petitioner functionally ineligible […] Read more
DHA Case No. MGE 211532 (Wis. Div. of Hearings and Appeals April 19, 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 applied August 8 and Income Maintenance did nothing until September 19, well beyond the 30-day […] Read more
DHA Case No. CWA 211105 (Wis. Div. of Hearings and Appeals April 19, 2024) (DHS) ↓ Download PDF The Department, through IRIS Consulting Agencies (ICAs), must ensure the health and safety of IRIS participants. The IRIS policy manual allows an application to be denied for “inability or unwillingness to develop an Individual Support and Service […] Read more