DHA Case No. MED 14/72307 (Wis. Div. of Hearings and Appeals March 17, 2006) (DHS) ↓ Download PDF Institutionalized MA recipients must pay their income towards their cost of care, but are allowed a deduction to pay for medical expenses not covered by MA. In this case, the petitioner owed the nursing home $3,500 for […] Read more
ALJ Brian C. Schneider
DHA Case No. FCP 210973 (Wis. Div. of Hearings and Appeals January 16, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the petitioner’s authorized representative failed to complete his renewal: she “apparently left employment with her payee company, […] Read more
DHA Case No. MGE 209328 (Wis. Div. of Hearings and Appeals December 5, 2023) (DHS) ↓ Download PDF An application for Institutional MA can be backdated up to three months before the month of application. The MEH provides that an application faxed and received by the agency after business hours counts as filed on the […] Read more
DHA Case No. MGE 209372 (Wis. Div. of Hearings and Appeals August 11, 2023) (DHS) ↓ Download PDF In general, a member must have at least ten days to provide required verification during a renewal. In this case, the agency sent a notice on July 3 requesting verification by July 10. Although he should have […] Read more
DHA Case No. MLL 209268 (Wis. Div. of Hearings and Appeals September 29, 2023) (DHS) ↓ Download PDF An applicant for an estate recovery waiver must file his or her application within 45 days of the Department’s notice. In this case, the petitioner filed it a month after the deadline, then appealed when the waiver […] Read more
DHA Case No. MGE 210503 (Wis. Div. of Hearings and Appeals December 19, 2023) (DHS) ↓ Download PDF After enrollment in a long-term care Medicaid program, the institutionalized spouse must spend down or transfer resources to the community spouse to get below $2,000 by the first renewal. In this case, the petitioner failed to do […] Read more
DHA Case No. FCP 210574 (Wis. Div. of Hearings and Appeals November 30, 2023) (DHS) ↓ Download PDF An MCO must give ten days’ notice of any adverse benefit determination. In this case, the petitioner’s MCO issued a notice on September 29 disenrolling her retroactive to August 21. ALJ Brian Schneider concluded the MCO had not […] Read more
DHA Case No. MGE 210319 (Wis. Div. of Hearings and Appeals October 20, 2023) (DHS) ↓ Download PDF In general, all available assets are counted and counted assets are not reduced by outstanding debt. In this case, the petitioner had excess assets at her renewal and an overpayment claim that was pending but not yet […] Read more
DHA Case No. MLL 209431 (Wis. Div. of Hearings and Appeals August 28, 2023) (DHS) ↓ Download PDF An applicant for a hardship waiver of estate recovery must file his or her application within 45 days of estate recovery’s claim, after which the applicant has 60 days to submit additional information. And if the applicant […] Read more
DHA Case No. CWA 205245 (Wis. Div. of Hearings and Appeals September 12, 2022) (DHS) ↓ Download PDF IRIS participants may hire their own workers to provide supportive home care (SHC). The participant is responsible for negotiating “reasonable and customary rates” with providers. In this case, the petitioner asked to increase her worker’s hourly rate […] Read more
DHA Case No. CWK 209490 (Wis. Div. of Hearings and Appeals September 15, 2023) (DHS) ↓ Download PDF The CLTS program can cover “Health and Wellness” services to maintain or improve the health, well being, socialization, or inclusion of the participant with family and peers in the community. But these services must not be duplicative […] Read more
DHA Case No. MQB 209768 (Wis. Div. of Hearings and Appeals November 14, 2023) (DHS) ↓ Download PDF QMB benefits normally begin on the first of the month after the month the person is determined eligible. In this case, the petitioner became eligible for Medicare in June but did not finish verification until July 5, […] Read more
DHA Case No. CWA 189325 (Wis. Div. of Hearings and Appeals January 8, 2019) (DHS) ↓ Download PDF When a person must use adaptive aids to perform an activity of daily living (ADL), this counts as needing assistance with the ADL for functional eligibility. In this case, the petitioner held onto the bed rail when […] Read more
DHA Case No. MDV 196288 (Wis. Div. of Hearings and Appeals December 4, 2019) (DHS) ↓ Download PDF Aland contract must have a term within the lender’s life expectancy, provide for equal payments, and not allow cancellation on the death of the lender to avoid being considered a divestment. In this case, the county argued […] Read more
DHA Case No. MDV 193440 (Wis. Div. of Hearings and Appeals June 11, 2019) (DHS) ↓ Download PDF A land contract must have a term within the lender’s life expectancy, provide for equal payments, and not allow cancellation on the death of the lender to avoid being considered a divestment. If it does not meet […] Read more