- Appellant denied for LTC benefits because she did not give MassHealth the information it needed to decide her eligibility within the required time frame. A disqualifying transfer of resources was found as the appellant recently gave away or sold assets to become eligible for MassHealth services. This transfer created a period of ineligibility.
Category: At Issue in Fair Hearing
Appeal 1601439
- Appellant failed to pay his patient paid amount so was sent a Notice of Intent to Discharge of Transfer. Records conclude that he has failed to pay for his stay at the nursing facility after reasonable and appropriate notice. Appeal denied.
Appeal 1600831
- Denied initially because assets were determined to exceed the limit for MassHealth. In appeal, out-of-state real estate held in the appellant’s spouse’s name is determined to be inaccessible and non-countable at this time. Therefore, appellant is eligible for MassHealth.
Appeal 1600128
- Appellant’s PPA lowered due to a change in countable income. MassHealth’s intent to place a lien on the appellant’s property was rescinded.
Appeal 1512837
Appellant will now be given the June 4, 2015 start date she is seeking; no longer a disqualifying transfer issue; additional information received from Appellant’s side related to Appellant’s reverse mortgage.
Appeal 1513371
The patient paid amount charged for May 2015 is incorrect; and therefore, the amount the nursing facility asserts that Appellant owes is also incorrect.
Appeal 1511917
Community spouse has not shown significant financial duress resulting from exceptional circumstances arising from her own medical condition, frailty, or similar special needs; regulations do not allow for the consideration of an institutionalized spouse’s outstanding bills in determining whether exceptional circumstances exist to warrant an increase in the SMND.
Appeal 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.
Appeal 1505979
The MassHealth regulation only allows an increase to the MMMNA for exceptional circumstances as outlined in the regulation and such circumstances do not include shelter costs, unless the shelter cost is related to the community spouse’s medical condition as in the case of an assisted living resident; the community spouse is 58 years old and there is no evidence of a medical condition that results in high out of pocket medical expenses; community spouse does not have extraordinary uncovered medical expenses arising from her medical condition that result in significant financial duress.
Appeal 1502486
Disqualifying transfer; appellant was the income beneficiary of a Trust that terminated in the same month she was admitted to the nursing facility; termination of the Trust was an action that was “taken to avoid receiving a resource to which the nursing facility resident or spouse is or would be entitled if such action had not been taken.”
MassHealth Appeals 