DHA Case No. MGE 207999 (Wis. Div. of Hearings and Appeals May 10, 2023) (DHS) ↓ Download PDF When a consumer is discharged from the Comprehensive Community Services (CCS) program and receives MA, they must first exhaust the grievance procedure at the local level before appealing to a fair hearing. The notice of discharge, however, […] Read more

DHA Case No. FCP 203910 (Wis. Div. of Hearings and Appeals March 23, 2023) (DHS) ↓ Download PDF If payments to a relative for services exceed 10% of the maximum CSAS, the MEH requires a notarized agreement. In this case, the petitioner had an agreement to pay her daughters $500 per month, but it was […] Read more

DHA Case No. FCP 189820 (Wis. Div. of Hearings and Appeals February 6, 2019) (DHS) ↓ Download PDF To be covered under Family Care, a service must be medically necessary. In this case, the petitioner’s request for acupuncture therapy was denied because it had been tried and proved ineffective for her in the past. ALJ […] Read more

DHA Case No. MGE 196927 (Wis. Div. of Hearings and Appeals January 28, 2020) (DHS) ↓ Download PDF The Department must give applicants adequate notice when requesting verification. In this case, the agency requested verification of a third-party discretionary trust but gave only 9 days to provide it and was not specific about the kind […] Read more

DHA Case No. MGE 198180 (Wis. Div. of Hearings and Appeals May 8, 2020) (DHS) ↓ Download PDF In general, an irrevocable trust established by either spouse is a countable, available asset if there are any circumstances under which the applicant could receive money from the trust. But this policy does not apply to a […] Read more

DHA Case No. MDV 198284 (Wis. Div. of Hearings and Appeals June 24, 2020) (DHS) ↓ Download PDF An undue hardship waiver for an institutionalized individual requires either an involuntary discharge notice from the facility or “other proof” that the individual will lack medical care or food, clothing, shelter, or other necessities. In this case, […] Read more

DHA Case No. MDV 199112 (Wis. Div. of Hearings and Appeals September 21, 2020) (DHS) ↓ Download PDF Divestment occurs at the time of a transfer for less than fair market value. In this case, the petitioner executed an agreement with her daughter in 2012 whereby her daughter made monthly payments and received incremental interests […] Read more

DHA Case No. MGE 201844 (Wis. Div. of Hearings and Appeals July 12, 2021) (DHS) ↓ Download PDF In determining patient liability, the Medicaid Eligibility Handbook allows a limited number of deductions from income. In this case, the petitioner could not afford to pay both his patient liability and his bankruptcy settlement. ALJ Kelly Cochrane could find […] Read more

DHA Case No. MDV 204093 (Wis. Div. of Hearings and Appeals March 24, 2022) (DHS) ↓ Download PDF A divestment penalty does not start until the date a Community Waivers applicant requests a waiver program, meets the functional screen criteria, and meets all other Medicaid eligibility requirements. In this case, the petitioner—represented by a lawyer—divested […] Read more

DHA Case No. MDV-45/86382 (Wis. Div. of Hearings and Appeals November 19, 2007) (DHS)  ↓ Download PDF Issue 1: Caretaker child The caretaker child exception allows an institutionalized person to transfer homestead property to a child who lived with the person and provided care for at least two years. In this case, the petitioner co-owned […] Read more