DHA Case No. CWK 210876 (Wis. Div. Hearings and Appeals Feb. 2, 2024) (DHS) ↓ Download PDF Relocation services under the CLTS program include “supports and essential items needed to establish a community living arrangement.” In this case, the petitioner asked for reimbursement for significant time spent by several people in packing, moving, and unpacking […] Read more

DHA Case No. CWA 211040 (Wis. Div. Hearings and Appeals Feb. 2, 2024) (DHS) ↓ Download PDF A budget amendment may be denied if it requests services that are duplicative of services already provided. In this case, the petitioner, an 18-year-old with Down Syndrome, requested a budget amendment to allow her to attend a 9-month […] Read more

DHA Case No. CWA 211308 (Wis. Div. Hearings and Appeals Jan. 25, 2024) (DHS) ↓ Download PDF IRIS participants choose needed supports and services to meet long-term care outcomes as identified in an Individual Support and Services Plan. In this case, the petitioner (a 29-year-old with autism) sought a budget amendment to pay for therapeutic […] Read more

DHA Case No. HMO 209818 (Wis. Div. Hearings and Appeals Jan. 11, 2024) (DHS) ↓ Download PDF An experimental or unproven treatment is not covered by MA as medically necessary. In this case, the petitioner’s request for a peripheral nerve stimulator was denied by her Medicaid HMO because it considered the treatment “unproven and not […] Read more

DHA Case No. CWK 210810 (Wis. Div. Hearings and Appeals Jan. 9, 2024) (DHS) ↓ Download PDF The CLTS program can pay for home modifications that “maximize a participant’s independent functioning in their home,” but not those that are merely “of general utility and not of direct medical or remedial benefit to them and in […] Read more

DHA Case No. CWK 210812 (Wis. Div. Hearings and Appeals Jan. 9, 2024) (DHS) ↓ Download PDF The CLTS program can pay for home modifications that “maximize a participant’s independent functioning in their home,” but not those that are merely “of general utility and not of direct medical or remedial benefit to them and in […] Read more

DHA Case No. CWA 210734 (Wis. Div. Hearings and Appeals Jan. 5, 2024) (DHS) ↓ Download PDF IRIS can pay for an already-trained service dog, but not an untrained dog or an emotional support dog. In this case, the petitioner requested funding to buy an untrained dog and then train it as a service animal. […] Read more

DHA Case No. FCP 210801 (Wis. Div. Hearings and Appeals Jan. 3, 2024) (DHS) ↓ Download PDF To be functionally eligible for Family Care, a person must fall into one of the program’s target groups in addition to needing a nursing home level of care. In this case, the petitioner was diagnosed with schizophrenia and […] Read more

DHA Case No. CWA 210721 (Wis. Div. Hearings and Appeals Jan. 3, 2024) (DHS) ↓ Download PDF The IRIS program can cover home modifications, but they must address the participant’s independence, health, safety, or long-term care needs and be cost effective. In this case, the petitioner made a one-time expense request to pay for a […] Read more

DHA Case No. CWA 214809 (Wis. Div. Hearings and Appeals Oct. 31, 2024) (DHS) ↓ Download PDF Because CLTS is the payor of last resort, all other benefits available to a participant must be accessed before the waiver funding may be used. In this case, the petitioner’s insurance covered speech therapy, but not the specific […] Read more

DHA Case No. CWA 213161 (Wis. Div. Hearings and Appeals Oct. 28, 2024) (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 participant was a […] Read more

DHA Case No. MDV 214370 (Wis. Div. Hearings and Appeals Oct. 22, 2024) (DHS) ↓ Download PDF The transfer of an exempt asset (except a homestead) is not a divestment. In this case, the petitioner bought a car—though she could not drive herself—that her son used to transport her to medical appointments. About seven months […] Read more

DHA Case No. MDD 214689 (Wis. Div. Hearings and Appeals Oct. 21, 2024) (DHS) ↓ Download PDF If the Social Security Administration finds an applicant not disabled within twelve months of a state MA application, that determination is binding on the state. In this case, the petitioner applied for SSI, SSDI, and state MA. Because […] Read more

DHA Case No. CWA 213537 (Wis. Div. Hearings and Appeals Oct. 18, 2024) (DHS) ↓ Download PDF The IRIS Policy Manual requires a notice of action and provides a right to appeal when services are reduced, terminated, or denied. In this case, the petitioner’s care worker failed to timely submit the required documentation to become […] Read more