Exceptional circumstances present; community spouse has exceptional care needs; MMMNA increased to cover necessities that arise from his medical condition; community spouse also entitled to keep all institutionalized spouse’s income and excess assets.
Author: Brian E. Barreira
Appellant suffers from medical conditions that cause her to incur high out-of-pocket expenses; these expenses cause financial distress; these medical issues plus financial distress constitute exceptional circumstance; MMMNA increased and patient paid amount decreased.
Appellant purchased annuity; was not disqualifying transfer because it occurred before the look-back period.
Nursing facility sought to discharge appellant for failing to pay; nursing facility failed to show sufficient preparation and orientation or that the discharge location is a safe and appropriate place.
Spouse needed to live in assisted living facility due to medical problems; exceptional circumstances resulting in financial duress; MMMNA increased.
Failure to pay facility; grounds sufficient for discharge; however, notice of intent was deficient due to lack of name of person at facility available to answer questions and assist appellant with appeal; also lack of documentation from physician.
Community spouse resides in assisted living facility; monthly fee includes heat, hot water, electricity, meals, and health insurance premium; hearing officer concluded no duplication of expenses by eliminating the MMMNA calculation and applying the actual costs associated with residing in the facility, so that spouse could continue to reside in facility.
Optional payments towards principal balance on home equity loan not deducted to calculate MMMNA; required minimum monthly payments are included, and MMMNA is increased accordingly.
There is a sound basis to increase the MMMNA; the community spouse has medical issues which require ongoing care and him residing in an assisted living facility.
Fair Hearing Decision 1600586(Remand)
- Appellant denied for benefits because he did not give MassHealth the information about his spouse’s assets and income that it needed to decide his eligibility.