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.
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.
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 did not support its position that only first mortgage expenses are allowed in the MMMNA calculation; MassHealth’s action in calculating Appellant’s MMMNA without factoring in the monthly expense for the second the mortgage is arbitrary and capricious.
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.
Community spouse has income amount less than MMMNA; spouse entitled to keep all of appellant’s income after PNA deduction; spouse entitled to all excess assets.
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.