DHA Case No. CWA 206737 (Wis. Div. of Hearings and Appeals January 18, 2023) (DHS) ↓ Download PDF The IRIS Policy Manual allows involuntary disenrollment for “mismanagement of employer authority.” In this case, the petitioner’s son and approved personal care worker became incarcerated; then the petitioner’s grandson, who had the same name, took over care […] Read more

DHA Case No. FCP 203910 (Wis. Div. of Hearings and Appeals March 23, 2023) (DHS) ↓ Download PDF If payments to a relative for services exceed 10% of the maximum CSAS, the MEH requires a notarized agreement. In this case, the petitioner had an agreement to pay her daughters $500 per month, but it was […] Read more

DHA Case No. MQB 209768 (Wis. Div. of Hearings and Appeals November 14, 2023) (DHS) ↓ Download PDF QMB benefits normally begin on the first of the month after the month the person is determined eligible. In this case, the petitioner became eligible for Medicare in June but did not finish verification until July 5, […] Read more

DHA Case No. MGE 209995 (Wis. Div. of Hearings and Appeals December 1, 2023) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” In this case, the agency did not explain […] Read more

DHA Case No. MGE 209934 (Wis. Div. of Hearings and Appeals November 13, 2023) (DHS) ↓ Download PDF Collectibles acquired or held because of their value as an investment are countable assets. In this case, the petitioner owned sports memorabilia worth about $35,000 but argued the collection was (1) unavailable due to the time it […] Read more

DHA Case No. MQB 209568 (Wis. Div. of Hearings and Appeals October 2, 2023) (DHS) ↓ Download PDF With the Public Health Emergency unwinding, members may voluntarily complete an early renewal, but Income Maintenance agencies must inform members that their eligibility may be impacted by doing an early renewal. In this case, the member’s renewal […] Read more

DHA Case No. FCP 189482 (Wis. Div. of Hearings and Appeals February 27, 2019) (DHS) ↓ Download PDF To be covered under Family Care, a service must be cost-effective. In this case, the MCO denied the petitioner’s request to install an ADA-height elongated toilet in his rented apartment, saying there were less costly alternatives. ALJ […] Read more

DHA Case No. FCP 189820 (Wis. Div. of Hearings and Appeals February 6, 2019) (DHS) ↓ Download PDF To be covered under Family Care, a service must be medically necessary. In this case, the petitioner’s request for acupuncture therapy was denied because it had been tried and proved ineffective for her in the past. ALJ […] Read more

DHA Case No. CWA 189840 (Wis. Div. of Hearings and Appeals January 24, 2019) (DHS) ↓ Download PDF IRIS can pay for a participant-hired worker to attend a conference as a “Community Integration Event” if the participant is also attending. In this case, the petitioner’s mother attended a Fragile X conference alone; she apparently was […] Read more

DHA Case No. FCP 189985 (Wis. Div. of Hearings and Appeals January 14, 2019) (DHS) ↓ Download PDF MCOs must consider an MA recipient’s income when determining benefits. In this case, the petitioner’s MCO reduced his out-of-benefit food budget when he started working, reasoning he could contribute that towards the cost of his food. ALJ […] Read more

DHA Case No. FCP 189984 (Wis. Div. of Hearings and Appeals January 14, 2019) (DHS) ↓ Download PDF MCOs must consider an MA recipient’s income when determining benefits. In this case, the petitioner’s MCO reduced his out-of-benefit food budget when he started receiving the state supplemental SSI payment, reasoning he could contribute that towards the […] Read more

DHA Case No. FCP 189662 (Wis. Div. of Hearings and Appeals January 14, 2019) (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 was enrolled in Family Care and receiving […] Read more

DHA Case No. CWA 189467 (Wis. Div. of Hearings and Appeals January 3, 2019) (DHS) ↓ Download PDF The IRIS program cannot cover nursing services that are already covered by the state Medicaid plan. In this case, the petitioner’s IRIS supportive home care (SHC) hours were reduced from 96 hours per week to 40 hours […] Read more

DHA Case No. CWA 189325 (Wis. Div. of Hearings and Appeals January 8, 2019) (DHS) ↓ Download PDF When a person must use adaptive aids to perform an activity of daily living (ADL), this counts as needing assistance with the ADL for functional eligibility. In this case, the petitioner held onto the bed rail when […] Read more