DHA Case No. MED 40/68266 (Wis. Div. of Hearings and Appeals June 27, 2005) (DHS) ↓ Download PDF A Medicaid recipient whose income exceeds the “medically needy” income limit must pay a deductible, which can be met by incurring medical expenses. In this case, the petitioner incurred charges for mental health services at the Milwaukee […] Read more

DHA Case No. MED 14/72307 (Wis. Div. of Hearings and Appeals March 17, 2006) (DHS) ↓ Download PDF Institutionalized MA recipients must pay their income towards their cost of care, but are allowed a deduction to pay for medical expenses not covered by MA. In this case, the petitioner owed the nursing home $3,500 for […] Read more

DHA Case No. MDV 40/68902 (Wis. Div. of Hearings and Appeals May 18, 2005) (DHS) ↓ Download PDF An institutionalized person may transfer homestead property to their child if the child lived with them and provided care keeping them out of an institution for at least two years immediately before becoming institutionalized. In this case, […] Read more

DHA Case No. MDV 40/54978 (Wis. Div. of Hearings and Appeals December 5, 2002) (DHS) ↓ Download PDF An institutionalized person may transfer homestead property to their child if the child lived with them and provided care keeping them out of an institution for at least two years immediately before becoming institutionalized. In this case, […] Read more

DHA Case No. MDV 49/44514 (Wis. Div. of Hearings and Appeals June 19, 2000) (DHS) ↓ Download PDF To qualify for the caretaker child exception to divestment, the child must “reside in” the institutionalized person’s home in addition to taking care of them. In this case, the petitioner’s son lived in his own, separately-taxed mobile […] Read more

DHA Case No. BCS 210387 (Wis. Div. of Hearings and Appeals January 12, 2024) (DHS) ↓ Download PDF In general, BadgerCare Plus counts all taxable income. However, the IRS allows some live-in care providers to list all payments as a business expense; in those circumstances, BadgerCare Plus also does not count these payments as income. […] Read more

DHA Case No. CWA 209367 (Wis. Div. of Hearings and Appeals January 4, 2024) (DHS) ↓ Download PDF Community Waivers enrollment can be backdated if agency error causes unreasonable delay. In this complicated case, the petitioner was first enrolled in IRIS during the pandemic as a 17- or 18-year-old under his mother’s name. His mother […] 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. BCS 210493 (Wis. Div. of Hearings and Appeals January 9, 2024) (DHS) ↓ Download PDF BadgerCare Plus eligibility is based on income and, unlike EBD Medicaid programs, taxable withdrawals from IRAs are counted as income. In this case, the petitioner was 63 and his only income was monthly withdrawals of $3,200 from […] Read more

DHA Case No. MED 53/97033 (Wis. Div. of Hearings and Appeals December 8, 2008) (DHS) ↓ Download PDF Home maintenance expenses only reduce the patient liability of an institutionalized recipient if a physician certifies the recipient is likely to return home within six months. In this case, the physician certified that the petitioner was not […] Read more

DHA Case No. HMO 210862 (Wis. Div. of Hearings and Appeals January 10, 2024) (DHS) ↓ Download PDF Although orthodontia is not usually covered by MA, it must be covered for recipients under age 21 if the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) health assessment and evaluation indicates that it is medically necessary. […] Read more

DHA Case No. CWA 210997 (Wis. Div. of Hearings and Appeals January 17, 2024) (DHS) ↓ Download PDF It is the guardian’s responsibility to complete a Medicaid renewal and to keep DHS informed when circumstances change. In this case, the petitioner changed guardians but neither guardian informed the agency, which then sent the renewal notices […] Read more

DHA Case No. MRA 70/105086 (Wis. Div. of Hearings and Appeals July 30, 2009) (DHS) ↓ Download PDF In general, an asset is counted if it is available—if the owner can access it and use it for support and maintenance. In this case, the agency counted as available a $7,233 check paid to and cashed […] Read more

DHA Case No. FCP 211106 (Wis. Div. of Hearings and Appeals January 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—but occasionally the screening program is wrong. In this case, the petitioner used […] Read more