Appeal 1813119

Fair Hearing Decision 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 1508928

Fair Hearing Decision 1508928

Health insurance premiums are not an extraordinary uncovered medical expense as the very nature of health insurance is that it covers certain medical services, thus insurance in and of itself would never be a covered medical expense; the MassHealth regulation only allows an increase to the MMMNA for exceptional circumstances as outlined in the above regulation and such circumstances do not include high shelter costs, unless the shelter cost is related to the community spouse’s medical condition as in the case of an assisted living resident.