The MassHealth regulation only allows an increase to the MMMNA for exceptional circumstances as outlined in the regulation and such circumstances do not include shelter costs, unless the shelter cost is related to the community spouse’s medical condition as in the case of an assisted living resident; the community spouse is 58 years old and there is no evidence of a medical condition that results in high out of pocket medical expenses; community spouse does not have extraordinary uncovered medical expenses arising from her medical condition that result in significant financial duress.