Spouse argued her net income, not gross income, should be considered; MassHealth may only consider gross income in determining whether she is entitled to SMND; as gross income is higher than MMMNA, she is not entitled to an SMND; increase in MMMNA not warranted because did not meet extraordinary circumstances test; utilities, groceries, car payments, cable, and phone not extraordinary circumstances.
Appellant suffers from medical conditions for which she incurs out-of-pocket expenses; appellant’s only income is her spousal allowance; expenses result in significant financial distress; exceptional circumstance exists.
Exceptional circumstances; medically necessary for husband to reside in assisted living facility; community spouse unable to live at home due to physical limitations and need for a specialized diet; financial duress as he is residing in assisted living facility that leaves him at significant monetary shortfall each month.
- Issue is whether Appellant is entitled to an adjustment to the PPA where his spouse was living in an assisted living facility. Appeal denied.
Community spouse did not meet exceptional circumstances criteria for increased Spousal Maintenance Needs Allowance; spouse testified she needed an increase to cover day-to-day bills and to assist her adult disabled child; regulations only allow increase where needs arise from medical condition, frailty, or similar special needs of the community spouse.
No exceptional circumstances; testified only to normal expenses such as rent and utilities; only medical expenses were co-pays.
- MassHealth determined that appellant is not eligible to receive MassHealth benefits due to excess countable assets. Ordered to rescind notice, re-open application, and determine the appellant’s eligibility based on the determination that the excess asset amount is now $0.
- Issue is whether the community spouse is entitled to an increase in the spousal maintenance needs allowance, based on exceptional circumstances. Appeal denied.
- MassHealth denied the appellant’s application. Ordered to re-determine eligibility based on the determination that the excess asset amount is now $0 after a shift of excess assets to the community spouse to help pay for a necessary stay in assisted living.
- Issue is whether MassHealth was correct in determining the appellant’s PPA to the nursing facility. MassHealth ordered to modify their calculations based on specific determinations.