5 Subprograms

MGE 170367 (03/02/2016)
Rented former home exempted as business property

Tags: 3 Financial Eligibility, 3.2 Assets, 3.2.7 Real property, 3.2.8 Business property, 3.3 Divestment, 3.3.07 Payments to relatives, 3.3.07.2 For services, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Michael D. O’Brien

DHA Case No. MGE 170367 (Wis. Div. of Hearings and Appeals March 2, 2016) (DHS) ↓ Download PDF This decision discussed two issues at some length. First, whether payments to the petitioner’s daughter were divestments; and second, whether the petitioner’s former home, now rented at fair market value, was countable. On the first issue, the […] Read more

MGE 185074 (03/14/2018)
Out-of-state home exempted

Tags: 2 Nonfinancial Eligibility, 2.2 Residency, 3 Financial Eligibility, 3.2 Assets, 3.2.7 Real property, 3.2.7.1 Homestead, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ John P. Tedesco

DHA Case No. MGE 185074 (Wis. Div. Hearings and Appeals March 14, 2018) (DHS) ↓ Download PDF In this straightforward decision, the petitioner owned home property in Michigan but was admitted to a Wisconsin nursing home. Her Medicaid application was denied because the agency “did not receive timely verification of any circumstance that would exempt […] Read more

MDV 195771 (01/09/2020)
No divestment for sale of multi-family homestead to son; paid FMV, not done with intent to qualify

Tags: 3 Financial Eligibility, 3.3 Divestment, 3.3.03 Transfers for FMV, 3.3.06 Transfers made for purpose other than to qualify for Medicaid, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Debra Bursinger

DHA Case No. MDV 195771 (Wis. Div. Hearings and Appeals January 9, 2020) (DHS) ↓ Download PDF In this case, the petitioner’s son bought her multi-family residential property, which had also been her home. A bank evaluation estimated the property’s fair market value at $225,000, and the tax assessment bill estimated it at $236,500. The […] Read more

FCP 193270 (06/14/2019)
Available assets reduced by checks mailed but not yet cashed

Tags: 3 Financial Eligibility, 3.2 Assets, 3.2.1 Availability, 5 Subprograms, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.1 Family Care, ALJ Teresa A. Perez

DHA Case No. FCP 193270 (Wis. Div. Hearings and Appeals June 14, 2019) (DHS) ↓ Download PDF In this case, the petitioner was receiving Family Care and owed monthly room and board to an assisted living facility. Due to an anomaly, the check for December was never delivered, resulting in it being reissued and mailed […] Read more

FCP 197076 (02/28/2020)
Cost share reduced by hardship waiver

Tags: 3 Financial Eligibility, 3.1 Income, 3.1.5 Unearned income, 3.1.5.23 Rental income, 3.1.8 Income deductions, 3.1.8.1 Maintaining home or apartment, 4 Program Administration, 4.5 Undue hardship, 5 Subprograms, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.2 Family Care Partnership, 5.05.8 Groups and cost sharing, ALJ Peter McCombs

DHA Case No. FCP 197076 (Wis. Div. Hearings and Appeals Feb. 28, 2020) (DHS) ↓ Download PDF In this case, the petitioner had a life estate in two properties, one in California and one in Wisconsin. Both were rented. But Dane County DHS did not reduce the petitioner’s cost share to allow her to pay […] Read more

MED 67/53178 (02/28/2003)
Failure to report divestment after initial application did not result in recoverable overpayment

Tags: 2 Nonfinancial Eligibility, 2.5 Change reporting, 3 Financial Eligibility, 3.3 Divestment, 4 Program Administration, 4.4 Overpayments, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Kenneth P. Adler

DHA Case No. MED 67/53178 (Wis. Div. Hearings and Appeals Feb. 28, 2003) (DHS) ↓ Download PDF In this case, a Medicaid recipient failed to report a divestment that occurred after her initial application was approved and benefits had started. The ALJ held that, despite the failure to report, the overpayment of benefits was not […] Read more

MDV 36/46674 (11/21/2000)
Divestment caused by automatic transfer provision in deed

Tags: 3 Financial Eligibility, 3.3 Divestment, 3.3.02 Look back period, 3.3.25 Life estates, 3.3.25.3 Life estate—termination and payment of less than FMV, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Brian C. Schneider

DHA Case No. MDV-36/46674 (Wis. Div. Hearings and Appeals Nov. 21, 2000) (DHS) ↓ Download PDF When a person, or another acting on the person’s behalf, acts to transfer property such as a life estate without receiving fair market value in return, it is a divestment. But what if the transfer happens automatically, because of […] Read more

MDV 197185 (03/02/2020)
No divestment for purchase of annuity beyond life expectancy

Tags: 3 Financial Eligibility, 3.3 Divestment, 3.3.06 Transfers made for purpose other than to qualify for Medicaid, 3.3.17 Irrevocable annuities, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Michael D. O’Brien

DHA Case No. MDV 197185 (Wis. Div. Hearings and Appeals Mar. 2, 2020) (DHS) ↓ Download PDF The petitioner’s husband bought an annuity with a term beyond his life expectancy, which is usually a divestment. The ALJ agreed with the argument, however, that the annuity was bought without the intent to qualify for Medicaid, warranting […] Read more

FCP 177326 (02/24/2017)
Family Care backdated to correct agency error

Tags: 1 Applications and Renewals, 1.1 Applications, 1.1.5 Begin dates, 5 Subprograms, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.1 Family Care, 5.05.7 Effective date, ALJ David D. Fleming

DHA Case No. FCP 177326 (Wis. Div. Hearings and Appeals Feb. 24, 2017) (DHS) ↓ Download PDF This case supports backdating Family Care eligibility when there is a delay in enrollment due to agency error. “Although there is no retroactive enrollment in the Family Care program, enrollment as of the date established in correction of […] Read more

MGE 174654 (07/27/2016)
Over-verification of irrelevant information

Tags: 4 Program Administration, 4.1 Verification, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ Michael D. O’Brien

DHA Case No. MGE 174654 (Wis. Div. Hearings and Appeals July 27, 2016) (DHS) ↓ Download PDF In this case, the county required a full five years of financial documentation because “there were a few discrepancies” in the initial documents provided. The applicant complied with more than 600 pages of documentation, plus authorizations for the […] Read more

MRA 167179 (12/11/2015)
The name on the check rule

Tags: 3 Financial Eligibility, 3.1 Income, 3.1.5 Unearned income, 3.4 Spousal impoverishment, 3.4.4 Non-trust income, 5 Subprograms, 5.04 Institutional Long-Term Care, ALJ David D. Fleming

DHA Case No. MRA 167179 (Wis. Div. Hearings and Appeals Dec. 11, 2015) (DHS) ↓ Download PDF This decision contains the classic “name on the check” rule. If income is paid only to the name of the community spouse, it is not countable as income to the institutionalized spouse—even if the income is from an […] Read more

MDV 155403 (04/30/2014)
Transfer of homestead to caretaker child was a divestment due to short stay in assisted living

Tags: 3 Financial Eligibility, 3.3 Divestment, 3.3.12 Homestead property, 3.3.12.4 Transfer of homestead to caretaker child, 5 Subprograms, 5.05 Home and Community-Based Waivers Long-Term Care, 5.05.1 Family Care, ALJ Sean P. Maloney

DHA Case No. MDV 155403 (Wis. Div. Hearings and Appeals Apr. 30, 2014) (DHS) ↓ Download PDF This decision finds that the exception to divestment for transferring the residence to a caretaker child does not apply when the applicant resides in an assisted living facility for even a short period of time before being approved for Family […] Read more

Newer Posts