DHA Case No. FCP 211586 (Wis. Div. of Hearings and Appeals March 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 ADRC told the petitioner not to apply for MA until after the functional screen was completed, […] Read more

DHA Case No. FCP 211142 (Wis. Div. of Hearings and Appeals March 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 filed an application October 10, but the agency never told his authorized representative of the […] Read more

DHA Case No. CWK 211595 (Wis. Div. of Hearings and Appeals March 22, 2024) (DHS) ↓ Download PDF The legal standards of functional eligibility for the Children’s Long-Term Support (CLTS) Waiver program and for the Katie Beckett program are identical. In this odd case, the petitioner was determined functionally ineligible for her CLTS renewal by […] Read more

DHA Case No. FCP 211940 (Wis. Div. of Hearings and Appeals March 19, 2024) (DHS) ↓ Download PDF In general, all Family Care services must be authorized before they are provided. In this case, the petitioner’s assisted living facility closed and he had to move to a new one. My Choice staff met with him […] Read more

DHA Case No. CWA 211353 (Wis. Div. of Hearings and Appeals March 14, 2024) (DHS) ↓ Download PDF DHS automatically disenrolls an IRIS participant when he or she loses basic Medicaid eligibility. In this case, the petitioner failed to get his renewal verification in on time and was disenrolled from Medicaid and IRIS. Although he […] Read more

DHA Case No. MDV 210958 (Wis. Div. of Hearings and Appeals March 13, 2024) (DHS) ↓ Download PDF The fair market value of real estate may be established by assessment, statements from realtors, or a comparative market analysis. In this case, the agency relied solely on the fair market value estimate it found on Zillow […] Read more

DHA Case No. CWA 211775 (Wis. Div. of Hearings and Appeals March 5, 2024) (DHS) ↓ Download PDF To be functionally eligible for IRIS, a person must be unable to safely or appropriately perform some combination of activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The Department’s instructions for completing the […] Read more

DHA Case No. FCP 211190 (Wis. Div. of Hearings and Appeals February 12, 2024) (DHS) ↓ Download PDF When applying for Family Care, Income Maintenance and the ADRC have 30 days to make their determinations of financial and functional eligibility. In this case, the petitioner was disenrolled November 1 due to excess assets, which her […] Read more

DHA Case No. FCP 211094 (Wis. Div. of Hearings and Appeals February 12, 2024) (DHS) ↓ Download PDF An MCO must develop an individual service plan that reasonably and effectively addresses the enrollee’s long-term care needs and outcomes, including needs for socialization and activities. In this case, the petitioner’s MCO stopped paying for adult day […] Read more

DHA Case No. CWA 211081 (Wis. Div. of Hearings and Appeals February 8, 2024) (DHS) ↓ Download PDF Tribal General Welfare Assistance (GWA) is exempt income only if it is based on the individual’s demonstration of need. In this case, the petitioner received GWA that was admittedly not based on need. ALJ Peter McCombs concluded […] Read more

DHA Case No. CWA 210975 (Wis. Div. of Hearings and Appeals January 24, 2024) (DHS) ↓ Download PDF One way to be functionally eligible for the IRIS program is to need help with one activity of daily living (ADL) and three instrumental activities of daily living (IADLs) and have a cognitive impairment. In this case, […] Read more

DHA Case No. FCP 210296 (Wis. Div. of Hearings and Appeals March 5, 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 agency denied the application in August after erroneously counting a burial asset. In October, after the […] Read more

DHA Case No. MGE 209474 (Wis. Div. of Hearings and Appeals January 5, 2024) (DHS) ↓ Download PDF To exempt funds in a pooled trust, an applicant for Medicaid must have a formal disability determination. In this case, the petitioner applied for community waivers Medicaid after establishing a pooled trust sub-account. Because he did not […] Read more

DHA Case No. MED 36/47216 (Wis. Div. of Hearings and Appeals July 24, 2001) (DHS) ↓ Download PDF Wisconsin’s spousal impoverishment law provides that the income of an institutionalized spouse (including a participant in Community Waivers) is not considered available to the community spouse. In this case, DHS had changed its policy so that the […] Read more