Wis. Admin. Code Department of Administration-Division of Hearings and Appeals § HA 3.03 - Right to appeal

Current through March 28, 2022

(1) Any person applying for or receiving medicaid, food stamps, social services or public assistance may appeal any of the following administrative actions of the department or an agency:
(a) Denial of an application for benefits or the overt denial of the right to apply.
(b) Failure to act on an application with reasonable promptness.
(c) Reduction, suspension or termination of program benefits.
(d) The determination of the amount, sufficiency, initial eligibility date of program benefits excluding COP program benefits.
(e) A change in the form of payment of benefits.
(f) For the COP program and medicaid waiver services, the denial of eligibility for services or reduction or termination of services as provided in s. 46.27(7m), Stats.
(g) A determination with regard to the preadmission screening and annual resident review requirements of section 1919(e)(7) of the Social Security Act of 1935, as amended.
(h) A decision to transfer or discharge a resident from a facility subject to the requirements of 42 CFR 483.12.
(i) A denial or termination of eligibility for medicaid under the Katie Beckett waiver program under section 1902(e)(3) of the Social Security Act.
(j) A decision to impose a medicaid lien or to deny a hardship waiver under s. 49.496, Stats.
(k) Any other decision or action affecting a medicaid applicant or enrollee where a hearing is required by law.
(L) A decision to deny a hardship waiver under s. 49.682(5), Stats., with regard to the recovery of benefits under a chronic disease program.
(m) The determination under s. 49.85, Stats., to recover an overpayment of benefits by means of certification to the Wisconsin department of revenue and the determination of the amount of such an overpayment as including an amount they believe has already been repaid or discharged in bankruptcy.
(n) A denial of an application for kinship care payment on the grounds specified in s. 48.57(3m) (am) 1, 2., 4., 4m. and 5., Stats., or the termination of kinship care payments.
(o) Removal of a child or any other decision or order by an agency or department that affects the head of a foster, treatment foster or group home or the children involved, per s. 48.64(4), Stats.
(2) An applicant for or recipient of medicaid may appeal a decision or order of a managed care entity which denies, reduces, terminates or otherwise limits services, which denies an enrollee's request for disenrollment or exemption from the entity or which otherwise adversely affects the individual.
(3) A former recipient of medicaid, food stamps, aid to families with dependent children or W-2 may appeal the determination that he or she has been overpaid benefits, the amount of such an overpayment still owing or whether it has been discharged in bankruptcy or the determination under s. 49.85, Stats., to recover such an overpayment by means of certification to the Wisconsin department of revenue.
(4) An applicant, recipient or former recipient may appeal any other adverse action or decision by an agency or department which affects their public assistance or social services benefits where a hearing is required by state or federal law or department policy.

Notes

Wis. Admin. Code Department of Administration-Division of Hearings and Appeals § HA 3.03
Cr. Register, November, 1999, No. 527, eff. 12-1-99.

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