DHA Case No. FCP 213736 (Wis. Div. Hearings and Appeals Aug. 28, 2024) (DHS) ↓ Download PDF A participant in Family Care can be involuntarily disenrolled if they are determined ineligible for MA. In this case, the petitioner submitted his renewal timely and was eligible, but his MCO disenrolled him in error and could not […] Read more

DHA Case No. MKB 214020 (Wis. Div. Hearings and Appeals Oct. 17, 2024) (DHS) ↓ Download PDF To be considered disabled for the Katie Beckett program, a child must have an impairment that causes marked and severe functional limitations. In this case, a 5-year-old girl was determined no longer eligible after her recertification in January […] Read more

DHA Case No. MKB 213737 (Wis. Div. Hearings and Appeals Aug. 22, 2024) (DHS) ↓ Download PDF To be considered disabled for the Katie Beckett program, a child must have an impairment that causes marked and severe functional limitations. In this case, a 4-year-old boy’s application was denied because his speech delay, pediatric feeding disorder, […] Read more

DHA Case No. MKB 213619 (Wis. Div. Hearings and Appeals Aug. 12, 2024) (DHS) ↓ Download PDF To be considered disabled for the Katie Beckett program, a child must have an impairment that causes marked and severe functional limitations. In this case, the petitioner was a 15-year-old boy who had hearing loss, narcolepsy, and sleep […] Read more

DHA Case No. CWA 213277 (Wis. Div. Hearings and Appeals Sep. 27, 2024) (DHS) ↓ Download PDF An IRIS participant may be involuntarily disenrolled for mismanagement of employer authority responsibilities. In this case, the petitioner had multiple instances of mismanagement with participant-hired workers, including calling the Fiscal Employer Agency posing as one of her workers, […] Read more

DHA Case No. FCP 213572 (Wis. Div. Hearings and Appeals Sep. 24, 2024) (DHS) ↓ Download PDF A service that is “duplicative with respect to other services being provided” is not medically necessary. In this case, the petitioner attended after-hours recreational activities in the community while living with her mother for many years. But when […] Read more

DHA Case No. BCS 213610 (Wis. Div. Hearings and Appeals Sep. 23, 2024) (DHS) ↓ Download PDF To determine self-employment income, Wisconsin Medicaid programs generally use the previous year’s federal tax return; but if the business had a “significant change in circumstances,” the agency must use anticipated earnings instead. In this case, the petitioner was […] Read more

DHA Case No. FCP 213852 (Wis. Div. Hearings and Appeals Sep. 12, 2024) (DHS) ↓ Download PDF Family Care enrollment may only be backdated when the agency has caused a delay after the application date. In this case, the petitioner mistakenly applied for Institutional MA in March and was found eligible before discovering that she […] Read more

DHA Case No. MRA 213308 (Wis. Div. Hearings and Appeals Jul. 31, 2024) (DHS) ↓ Download PDF A Community Waivers member in Group B or B Plus may use spousal improverishment rules to give income to his or her spouse as an “institutionalized person,” but Group A members are excluded from that definition. In this […] Read more

DHA Case No. CWA 213191 (Wis. Div. Hearings and Appeals Jul. 15, 2024) (DHS) ↓ Download PDF Community Waivers members in Groups B and B Plus may use spousal improverishment rules to give income to their spouses, but Group A members may not. In this case, the petitioner was enrolled in Group B in 2019 […] Read more

DHA Case No. CWA 213089 (Wis. Div. Hearings and Appeals Jul. 2, 2024) (DHS) ↓ Download PDF The agency may deny an application for IRIS during the referral stage if the applicant committed substantiated fraud during a previous enrollment. In this case, the petitioner was previously enrolled in IRIS and the agency had issued a […] Read more

DHA Case No. MDV 177535 (Wis. Div. Hearings and Appeals Feb. 9, 2017) (DHS) ↓ Download PDF When a Medicaid applicant can show that transfers to family members were made for a purpose other than to qualify for Medicaid, those transfers are not divestments. In this case, the petitioner made more than a hundred small […] Read more

DHA Case No. MDV 190237 (Wis. Div. Hearings and Appeals Dec. 13, 2018) (DHS) ↓ Download PDF Any transfer of resources for less than fair market value is generally a divestment, but there is an exception if the resource was transferred “exclusively for some other purpose than to become eligible for MA.” In this case, […] Read more

DHA Case No. MDV 71/35825 (Wis. Div. Hearings and Appeals Aug. 28, 1998) (DHS) ↓ Download PDF It is generally a divestment to sell real estate for less than its fair market value. In this case, the petitioner sold his home on the market for $62,000, less than its tax-assessed value of $72,100. ALJ Kenneth […] Read more