DHA Case No. BCS 207050 (Wis. Div. of Hearings and Appeals February 8, 2023) (DHS) ↓ Download PDF A Medicaid appeal must be filed within 45 days of a negative action. In this case, the petitioner’s mother contacted the agency in May 2020 to report getting a job and ask for her BadgerCare Plus benefits […] Read more

DHA Case No. CWK 206852 (Wis. Div. of Hearings and Appeals January 10, 2023) (DHS) ↓ Download PDF Vehicle modifications are allowed as a benefit of the Children’s Long-Term Support program, but they must “meet all applicable standards of manufacture, safety, design, and installation.” In this case, the petitioner’s mother asked for a modification to […] Read more

DHA Case No. MDD 206834 (Wis. Div. of Hearings and Appeals March 28, 2023) (DHS) ↓ Download PDF To be eligible for MAPP, an applicant must meet the SSI definition of disability. In this case, the petitioner was a 64-year-old woman with a high school diploma; diagnoses including Bipolar Disorder, ADHD, PTSD, torn rotator cuff, […] Read more

DHA Case No. MAC 206795 (Wis. Div. of Hearings and Appeals February 8, 2023) (DHS) ↓ Download PDF To prevail at an appeal regarding an Order to Compel Payment of MA/BCP Liability, the agency must show, to begin with, that it provided proper notice of the underlying overpayment. Proper notice must include both the right […] Read more

DHA Case No. CWA 202841 (Wis. Div. of Hearings and Appeals January 5, 2022) (DHS) ↓ Download PDF An IRIS participant may request a budget amendment to pay for an ongoing need not met within the current budget. In this case, the petitioner asked for a budget increase from $15 to $17/hr to pay for […] Read more

DHA Case No. CWA 202831 (Wis. Div. of Hearings and Appeals November 29, 2021) (DHS) ↓ Download PDF An IRIS participant must use up private duty nursing (PDN) hours before using supportive home care (SHC) or companion care hours. In this case, the petitioner was found eligible for 24/7 PDN services; her supportive home care […] Read more

DHA Case No. MKB 200405 (Wis. Div. of Hearings and Appeals January 6, 2021) (DHS)  ↓ Download PDF The final step in the disability determination process for the Katie Beckett program is determining if the child has “marked limitations” in two of six domains or an “extreme limitation” in one. In this case, the DDB […] Read more

DHA Case No. MKB 200264 (Wis. Div. of Hearings and Appeals January 11, 2021) (DHS)  ↓ Download PDF The final step in the disability determination process for the Katie Beckett program is determining if the child has “marked limitations” in two of six domains or an “extreme limitation” in one. In this case, the DDB […] Read more

DHA Case No. FCP 163632 (Wis. Div. of Hearings and Appeals April 13, 2015) (DHS) ↓ Download PDF Family Care benefits generally cannot be backdated, except that retroactive enrollment can be ordered by an ALJ to correct delay caused by agency error. This is an early case where the agency delayed sending a request for […] Read more

DHA Case No. FCP 176566 (Wis. Div. of Hearings and Appeals December 28, 2016) (DHS) ↓ Download PDF Family Care eligibility generally cannot be backdated, but retroactive enrollment can be ordered by an ALJ to correct delay caused by agency error. In this case, the petitioner’s enrollment in Family Care was delayed because the ADRC took […] Read more

DHA Case No. FCP 196128 (Wis. Div. of Hearings and Appeals January 2, 2020) (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’s functional screen found her functionally ineligible because […] Read more

DHA Case No. CWA 195974 (Wis. Div. of Hearings and Appeals January 6, 2020) (DHS) ↓ Download PDF The Department must ensure the health and safety of IRIS participants. The IRIS policy manual allows involuntary disenrollment for “health and safety risks that participants are unable or unwilling to resolve.” In this case, the petitioner refused […] Read more

DHA Case No. MGE 194293 (Wis. Div. of Hearings and Appeals January 6, 2020) (DHS) ↓ Download PDF The amount a community spouse can keep depends on the couple’s total resources on the date of the asset assessment, which is often the date a functional screen was completed and the person was determined functionally eligible. […] Read more

DHA Case No. MGE 196806 (Wis. Div. of Hearings and Appeals January 9, 2020) (DHS) ↓ Download PDF An applicant must be under the asset limit as of the last day of the month for that month’s eligibility. In this case, the petitioner’s eligibility for August was denied because her bank statement showed a high […] Read more