Community spouse’s total income less than MMMNA; community spouse entitled to keep all of institutionalized spouse’s income and excess assets.
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.
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.
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.
- Issue is whether MassHealth was correct in determining that the appellant’s spouse’s assets exceed the limit for MassHealth. Other issue is whether the appellant is allowed to retain the excess assets in order to meet her MMMNA. Appeal is approved.
- 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.
- Appeal is whether the PPA should be reduced to reflect an increase in the MMMNA for the community spouse. Appeal denied.
- Appeals calculation of the PPA. MassHealth ordered to recalculate the PPA because the community spouse needs more income to make mortgage payments.