DHA Case No. CWK 212281 (Wis. Div. Hearings and Appeals May 20, 2024) (DHS) ↓ Download PDF To be functionally eligible for the CLTS program, a child must require an institutional level of care and be in a target group (intellectual/developmental disability, physical disability, or mental health disability). In this case, the petitioner was found […] Read more

DHA Case No. CWA 212824 (Wis. Div. Hearings and Appeals Jun. 26, 2024) (DHS) ↓ Download PDF The Department may deny an IRIS budget amendment (BA) request if it is not cost-effective or necessary to achieve the participant’s long-term care outcomes. In this case, the petitioner sought a BA to fund a 4% increase in […] Read more

DHA Case No. FCP 211691 (Wis. Div. Hearings and Appeals Mar. 20, 2024) (DHS) ↓ Download PDF To be functionally eligible for Community Waivers long-term care programs, a person must fall into one of the target groups (frail elder, physical disability, or developmental disability) in addition to needing a nursing home level of care. In […] Read more

DHA Case No. CWA 212224 (Wis. Div. of Hearings and Appeals July 3, 2024) (DHS) ↓ Download PDF Family Care enrollment may be backdated if agency error causes a delay in enrollment. In this case, the ADRC completed the functional screen on October 31 but did not notify IM of the referral until January 10. […] Read more

DHA Case No. CWK 212683 (Wis. Div. of Hearings and Appeals July 11, 2024) (DHS) ↓ Download PDF County Waiver Agencies (CWAs) are required to have written policies to address conflicts of interest. In this case, the CWA removed a respite provider that was owned by the member’s parent, claiming a conflict of interest. ALJ […] Read more

DHA Case No. FCP 213209 (Wis. Div. of Hearings and Appeals June 27, 2024) (DHS) ↓ Download PDF A Family Care member can be involuntarily disenrolled if they lose or are determined ineligible for MA. In this case, the petitioner was disenrolled when the agency failed to test her for Community Waivers eligibility while processing […] Read more

DHA Case No. WFC 213597 (Wis. Div. of Hearings and Appeals June 25, 2024) (DHS) ↓ Download PDF The Wisconsin Funeral and Cemetery Aids Program (WFCAP) pays a portion of the cemetery expenses and funeral and burial expenses of indigent recipients of AFDC, W-2 benefits, SSI, or Medicaid under certain circumstances. In this case, the […] Read more

DHA Case No. CWA 212112 (Wis. Div. of Hearings and Appeals June 7, 2024) (DHS) ↓ Download PDF IRIS may pay for a vehicle modification as a one-time expense (OTE) request, but it must be cost-effective and all other options for funding must be exhausted first. In this case, the 20-year-old petitioner requested a $102,000 […] Read more

DHA Case No. CWA 212568 (Wis. Div. of Hearings and Appeals June 6, 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 was determined functionally and financially eligible as of December 14, but Income Maintenance simply failed […] Read more

DHA Case No. MGE 211474 (Wis. Div. of Hearings and Appeals May 20, 2024) (DHS) ↓ Download PDF IRIS Consultant Agencies (ICAs) must now help participants maintain MA eligibility, including monitoring and reporting any medical or remedial expenses. In this case, the petitioner had more than $2,000 in privately paid personal care expenses that were […] Read more

DHA Case No. MGE 212097 (Wis. Div. of Hearings and Appeals May 6, 2024) (DHS) ↓ Download PDF When there is a change in anticipated self-employment earnings, the MEH generally requires the agency to average the most recent months of earnings that reflect the changed circumstances. In this case, the petitioner had royalty income from […] Read more

DHA Case No. FCP 212098 (Wis. Div. of Hearings and Appeals April 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 petitioner claimed to have sent verification of assets being below $2,000 in December—via ACCESS and, a […] Read more

DHA Case No. MLL 211310 (Wis. Div. of Hearings and Appeals February 19, 2024) (DHS) ↓ Download PDF When an heir applies for a hardship waiver of an estate recovery claim, the heir  must include documents establishing his or her relationship to the decedent. In this case, the heir failed to document her relationship, though […] Read more

DHA Case No. MGE 209925 (Wis. Div. of Hearings and Appeals January 12, 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 was eligibile on July 6 but not enrolled until July 21 because the ADRC mistakenly […] Read more