5 Subprograms

DHA Case No. MDV 198638 (Wis. Div. of Hearings and Appeals June 29, 2020) (DHS) ↓ Download PDF A divestment penalty for a Medicaid applicant begins on the date the person applies and is “otherwise eligible” but for the divestment; it begins for a member the first of the month after the member receives timely notice. In this case, […] Read more

DHA Case No. FCP 177944 (Wis. Div. of Hearings and Appeals December 13, 2016) (DHS) ↓ Download PDF It is a divestment when a life estate is terminated and the life estate holder is not paid her proportional share. In this case, the petitioner’s life estate was divested when she sold her home and her […] Read more

DHA Case No. MDV 183502 (Wis. Div. of Hearings and Appeals December 6, 2017) (DHS) ↓ Download PDF Adivestment occurs upon the transfer of a non-exempt resource for less than fair market value. In this simple case, the petitioner sold the home in which she had a life estate and paid a prorated portion of […] Read more

DHA Case No. MDV 199112 (Wis. Div. of Hearings and Appeals September 21, 2020) (DHS) ↓ Download PDF Divestment occurs at the time of a transfer for less than fair market value. In this case, the petitioner executed an agreement with her daughter in 2012 whereby her daughter made monthly payments and received incremental interests […] Read more

DHA Case No. MDV 199858 (Wis. Div. of Hearings and Appeals December 4, 2020) (DHS) ↓ Download PDF Divestment is a transfer of non-exempt resources for less than fair market value. This case involved two potential divestments when the petitioner’s house was sold to her daughter and daughter’s boyfriend: (1) the boyfriend was paid $40,534.37 […] Read more

DHA Case No. MAP 199545 (Wis. Div. of Hearings and Appeals December 17, 2020) (DHS) ↓ Download PDF Medicaid applicants must have adequate notice of the proof needed to verify their assets. In this case, the agency issued a Notice of Proof Needed after finding additional accounts in the Asset Verification System (AVS), but the […] Read more

DHA Case No. MDV 200210 (Wis. Div. of Hearings and Appeals January 21, 2021) (DHS) ↓ Download PDF An appeal must be filed within 45 days of an agency action for the ALJ to have jurisdiction to review it. In this case, the petitioner established an irrevocable trust, divested, and applied for Medicaid in May […] Read more

DHA Case No. MGE 200475 (Wis. Div. of Hearings and Appeals February 8, 2021) (DHS) ↓ Download PDF Eligibility for MA begins the first of the month in which the applicant meets all program requirements. In this case, the petitioner planned for a divestment penalty with a Medicaid-compliant annuity, but the final annuity payment occurred […] Read more

DHA Case No. MGE 199939 (Wis. Div. of Hearings and Appeals April 19, 2021) (DHS) ↓ Download PDF Non-homestead real estate is countable unless it is listed for sale with a realtor. In this unusual case, the petitioner owned some land with a mobile home, but realtors refused to list it because of its condition […] Read more

DHA Case No. MDD 200680 (Wis. Div. of Hearings and Appeals February 10, 2021) (DHS) ↓ Download PDF In making a disability determination, the Disability Determination Bureau (DDB) applies a 5-step test. Step 5 considers whether the individual can adjust to types of work the individual has not performed in the past, considering his or […] Read more

DHA Case No. MOP 200346 (Wis. Div. of Hearings and Appeals February 10, 2021) (DHS) ↓ Download PDF In an overpayment hearing, the agency has the burden to prove, by the preponderance of the evidence, both that the petitioner failed to provide accurate or complete information and that the petitioner was not eligible during the […] Read more

DHA Case No. MDV 201093 (Wis. Div. of Hearings and Appeals March 8, 2021) (DHS) ↓ Download PDF Using an inheritance to buy personal property for fair market value is not a divestment, but the purchases must be verified. In this case, the petitioner inherited $9,633 and claimed to have spent it on a desk, […] Read more

DHA Case No. MGE 201671 (Wis. Div. of Hearings and Appeals June 15, 2021) (DHS) ↓ Download PDF A Medicaid member must have adequate notice of any change in his or her patient liability. In this case, the petitioner elected online notices and a notice of patient liability was posted to her ACCESS account. Her […] Read more

DHA Case No. MGE 201844 (Wis. Div. of Hearings and Appeals July 12, 2021) (DHS) ↓ Download PDF In determining patient liability, the Medicaid Eligibility Handbook allows a limited number of deductions from income. In this case, the petitioner could not afford to pay both his patient liability and his bankruptcy settlement. ALJ Kelly Cochrane could find […] Read more