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 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. 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. 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. 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 208558 (Wis. Div. Hearings and Appeals Feb. 26, 2024) (DHS) (proposed decision on cost motion) ↓ Download PDF Under the Wisconsin Equal Access to Justice Act (WEAJA), petitioners who prevail in a fair hearing are entitled to an award of costs unless the agency’s action was “substantially justified.” In this case, […] Read more

DHA Case No. CWA 208558 RHG (Wis. Div. Hearings and Appeals Sep. 5, 2023) (DHS) (decision on rehearing) ↓ Download PDF Participants in IRIS may submit a budget amendment (BA) request to increase their budget to pay for an ongoing need not met within the current budget. In this case, the petitioner submitted a BA […] Read more

DHA Case No. CWA 208558 (Wis. Div. Hearings and Appeals Jul. 26, 2023) (DHS) ↓ Download PDF Participants in the IRIS program have certain rights to appeal that do not extend to providers. In this case, the petitioner appealed the denial of his budget amendment request to increase the rate paid to his supportive home […] Read more

DHA Case No. MGE 198675 (Wis. Div. of Hearings and Appeals August 5, 2020) (DHS) ↓ Download PDF An asset is unavailable if a member lacks the ability to provide legal access, no one else can access the asset, and a process has been started to get legal access. In this case, the petitioner was […] Read more

DHA Case No. MRA 210683 (Wis. Div. of Hearings and Appeals January 8, 2024) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” In this case, the community spouse had many […] Read more

DHA Case No. FCP 206397 (Wis. Div. of Hearings and Appeals January 17, 2023) (DHS) ↓ Download PDF Family Care generally does not cover household repairs or improvements that are not directly related to the member’s care. In this case, the petitioner’s carpet was fouled and beyond cleaning, so she asked her MCO to replace […] Read more