DHA Case No. MED 70/82111 (Wis. Div. of Hearings and Appeals February 28, 2007) (DHS) ↓ Download PDF The asset limit for Institutional MA is $2,000. In this case, the petitioner misidentified a savings account as life insurance on her application. The county worker, who was “simply scanning the application” at the time, advised the […] Read more

DHA Case No. MGE 212813 (Wis. Div. of Hearings and Appeals June 28, 2024) (DHS) ↓ Download PDF Family Care enrollment may be backdated if agency error causes a delay in enrollment. In this case, the agency requested verification of a new funeral trust—which the petitioner had created but not reported during the pandemic—during a […] Read more

DHA Case No. CWA 213069 (Wis. Div. of Hearings and Appeals June 28, 2024) (DHS) ↓ Download PDF Family Care enrollment may be backdated if agency error causes a delay in enrollment, but only back to the first date the person was determined functionally eligible, was determined MA eligible, and had signed the enrollment form. […] Read more

DHA Case No. MLL 212171 (Wis. Div. of Hearings and Appeals July 9, 2024) (DHS) ↓ Download PDF When estate recovery makes a claim, Wisconsin law gives a right to appeal the issues of the value of the property and the extent of the decedent’s interest in it. In this case, the petitioner and the […] Read more

DHA Case No. MGE 211532 (Wis. Div. of Hearings and Appeals April 19, 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 applied August 8 and Income Maintenance did nothing until September 19, well beyond the 30-day […] Read more

DHA Case No. FCP 211741 (Wis. Div. of Hearings and Appeals April 17, 2024) (DHS) ↓ Download PDF Beginning on the date of enrollment, an MCO must pay for needed services, including the continuation of current services “necessary to ensure health and safety and continuity of care,” until the full assessment and member-centered plan are […] Read more

DHA Case No. MAP 212440 (Wis. Div. of Hearings and Appeals April 16, 2024) (DHS) ↓ Download PDF Applicants for Medicaid are given at least 20 days from the date of a request to provide verification, and benefits may only be denied if the applicant has the power to produce the verification. In this case, […] Read more

DHA Case No. FCP 211586 (Wis. Div. of Hearings and Appeals March 26, 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 ADRC told the petitioner not to apply for MA until after the functional screen was completed, […] Read more

DHA Case No. FCP 211940 (Wis. Div. of Hearings and Appeals March 19, 2024) (DHS) ↓ Download PDF In general, all Family Care services must be authorized before they are provided. In this case, the petitioner’s assisted living facility closed and he had to move to a new one. My Choice staff met with him […] Read more

DHA Case No. MLL 211983 (Wis. Div. of Hearings and Appeals March 18, 2024) (DHS) ↓ Download PDF A hardship waiver for estate recovery must be mailed within 45 days of the notice from DHS. In this tragic case, the waiver was due December 25. The petitioner called Estate Recovery on December 18 to ask […] Read more

DHA Case No. CWK 210726 (Wis. Div. of Hearings and Appeals March 15, 2024) (DHS) ↓ Download PDF Individual choice of provider is a main tenant of the CLTS program. Even when a background check on a proposed provider reveals negative—but not disqualifying—findings, the County Waiver Agency must respect the participant’s choice “unless there is […] Read more

DHA Case No. CWA 211775 (Wis. Div. of Hearings and Appeals March 5, 2024) (DHS) ↓ Download PDF To be functionally eligible for IRIS, a person must be unable to safely or appropriately perform some combination of activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The Department’s instructions for completing the […] Read more

DHA Case No. FCP 211190 (Wis. Div. of Hearings and Appeals February 12, 2024) (DHS) ↓ Download PDF When applying for Family Care, Income Maintenance and the ADRC have 30 days to make their determinations of financial and functional eligibility. In this case, the petitioner was disenrolled November 1 due to excess assets, which her […] Read more

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