DHA Case No. CWK 212281 (Wis. Div. Hearings and Appeals May 20, 2024) (DHS) ↓ Download PDF To be functionally eligible for the CLTS program, a child must require an institutional level of care and be in a target group (intellectual/developmental disability, physical disability, or mental health disability). In this case, the petitioner was found […] Read more

DHA Case No. CWK 212876 (Wis. Div. Hearings and Appeals Jul. 15, 2024) (DHS) ↓ Download PDF The CLTS program covers home modifications that maximize a participant’s independent functioning in their home. In this case, the petitioner was an autistic child with destructive behaviors. His mother requested durable, solid-wood kitchen cabinetry because he would break […] Read more

DHA Case No. CWK 213060 (Wis. Div. Hearings and Appeals Jul. 15, 2024) (DHS) ↓ Download PDF The parent or caretaker of a CLTS participant may have respite services provided in another’s home if the length of stay is 72 hours or less, even if background checks cannot be completed on all the residents in […] Read more

DHA Case No. CWK 213700 (Wis. Div. Hearings and Appeals Aug. 30, 2024) (DHS) ↓ Download PDF Educational services funded by the Department of Public Instruction cannot also be covered under CLTS’ “Empowerment and Self-Determination Supports” service code. In this case, the petitioner was initially approved to see a one-on-one provider for help with functional […] Read more

DHA Case No. CWK 210876 (Wis. Div. Hearings and Appeals Feb. 2, 2024) (DHS) ↓ Download PDF Relocation services under the CLTS program include “supports and essential items needed to establish a community living arrangement.” In this case, the petitioner asked for reimbursement for significant time spent by several people in packing, moving, and unpacking […] Read more

DHA Case No. CWK 210810 (Wis. Div. Hearings and Appeals Jan. 9, 2024) (DHS) ↓ Download PDF The CLTS program can pay for home modifications that “maximize a participant’s independent functioning in their home,” but not those that are merely “of general utility and not of direct medical or remedial benefit to them and in […] Read more

DHA Case No. CWK 210812 (Wis. Div. Hearings and Appeals Jan. 9, 2024) (DHS) ↓ Download PDF The CLTS program can pay for home modifications that “maximize a participant’s independent functioning in their home,” but not those that are merely “of general utility and not of direct medical or remedial benefit to them and in […] Read more

DHA Case No. CWA 214809 (Wis. Div. Hearings and Appeals Oct. 31, 2024) (DHS) ↓ Download PDF Because CLTS is the payor of last resort, all other benefits available to a participant must be accessed before the waiver funding may be used. In this case, the petitioner’s insurance covered speech therapy, but not the specific […] Read more

DHA Case No. CWK 212683 (Wis. Div. of Hearings and Appeals July 11, 2024) (DHS) ↓ Download PDF County Waiver Agencies (CWAs) are required to have written policies to address conflicts of interest. In this case, the CWA removed a respite provider that was owned by the member’s parent, claiming a conflict of interest. ALJ […] Read more

DHA Case No. CWK 211734 (Wis. Div. of Hearings and Appeals April 26, 2024) (DHS) ↓ Download PDF To be eligible for the Children’s Long-Term Support program (CLTS), the child must meet an institutional level of care as determined by the program’s specific functional screen. In this case, the agency sought to disenroll the petitioner […] 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. CWK 210726 (Wis. Div. of Hearings and Appeals March 15, 2024) (DHS) ↓ Download PDF Individual choice of provider is a main tenant of the CLTS program. Even when a background check on a proposed provider reveals negative—but not disqualifying—findings, the County Waiver Agency must respect the participant’s choice “unless there is […] Read more

DHA Case No. CWK 210573 (Wis. Div. of Hearings and Appeals January 9, 2024) (DHS) ↓ Download PDF The CLTS program can cover respite care to ease “the daily stress and care demands” for the participant’s family “on a short-term basis.” In this case, the petitioner was an 8-year-old with autism. His mother had a […] Read more

DHA Case No. CWK 209490 (Wis. Div. of Hearings and Appeals September 15, 2023) (DHS) ↓ Download PDF The CLTS program can cover “Health and Wellness” services to maintain or improve the health, well being, socialization, or inclusion of the participant with family and peers in the community. But these services must not be duplicative […] Read more