The hearing officer ruled that the primary beneficiary of a spousal annuity does not have to be “Commonwealth of Massachusetts” without limiting language. Since the MassHealth regulation only allows estate recovery to the extent of MassHealth benefits correctly paid, the beneficiary language can be limited to track the regulation.
Category: At Issue in Fair Hearing
Transfer of resources for less than fair market value; appellant retained access to assets in irrevocable trust; trustee then distributed trust assets to children; appellant and spouse changed beneficiaries of spouse’s IRAs to children; spouse passed away 17 days later; not relevant whether trustee was exercising fiduciary duty.
Trust cannot be considered countable asset; MassHealth counted $16,000 held in a revocable trust established by the spouse who is now deceased; spouse’s will left estate to appellant; appellant’s attorney currently unable to find someone willing to be trustee (terms of trust require corporate trustee with 50 years management experience); upon spouse’s death assets are supposed to be divided into two trusts; appellant is only beneficiary of one of them; amount to be distributed to marital trust if any is the minimum amount that would allow the trust to qualify for the federal estate tax deduction; amount to be distributed unknown and could be as little as nothing.
Reason for planned discharge not supported by documentation of testimonial evidence; facility did not demonstrate that appellant’s behavior endangers others; documentation provided by facility does not support reason for discharge; at the hearing the facility did not address the discharge plan to the shelter nor did it provide information about how appellant could be cared for in the community setting.
No exceptional circumstances and no significant financial duress; none of the itemized expenses arose from medical condition, frailty or similar special needs of the community spouse; the community spouse asserted monthly expenses exceeding the current MMMNA maximum by $65; the hearing officer concluded this was too small of a difference to constitute significant financial duress.
Community spouse’s total income less than MMMNA; community spouse entitled to keep all of institutionalized spouse’s income and excess assets.
MassHealth correctly calculated community spouse’s MMMNA and appellant’s PPA; spouse had monthly medical bills of $177; hearing officer said this was not causing significant financial duress, especially given that there were other living expenses that could have been reduced in order to pay the medical bills; other expenses which community spouse wished to have covered were not necessities arising from the medical condition, frailty, or similar special needs of the community spouse.
No increase in MMMNA warranted; community spouse has financial duress but no exceptional circumstances; past due medical bills consisting of small co-pay amounts accumulated since 2014; these are small typical charges incurred in the normal course by individuals with health insurance.
Facility did not provide appellant with sufficient preparation and orientation to ensure a safe and orderly discharge from the facility to another safe and appropriate place; facility did not designate a discharge location; clinical record lacks progress note from physician to document he no longer needs the facility’s services; no progress note by physician documenting appellant’s danger to safety of other residents.
MMMNA not increased; no exceptional circumstances; spouse did not incur any extraordinary expenses arising from her own medical conditions.