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.
Category: Exceptional circumstances
Appeal 1807592
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.
Appeal 1813119
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.
Appeal 1813535
MMMNA not increased; no exceptional circumstances; spouse did not incur any extraordinary expenses arising from her own medical conditions.
Appeal 1810169
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.
Appeal 1811347
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.
Appeal 1804279
Spouse needed to live in assisted living facility due to medical problems; exceptional circumstances resulting in financial duress; MMMNA increased.
Appeal 1810282
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.
Appeal 1807201
MMMNA was lower than what MassHealth calculated and therefore new allowable MMMNA is higher; no spousal deduction from appellant’s income because no extraordinary circumstances; medical expenses and water bill not extraordinary.
Appeal 1805493
Community spouse did not meet exceptional circumstances criteria for increased Spousal Maintenance Needs Allowance; spouse said she needed an increase to cover two mortgages, heat, light, and credit card bills; but federal standards used when calculated MMMNA already covers utilities, shelter, and other day-to-day expenses so these are not exceptional circumstances.
MassHealth Appeals 