(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.
