Nursing facility’s notice simply does not comply with many requirements of Massachusetts law; nowhere in the notice is the specific name of the contact person at the facility given; the address of an appropriate legal services offices be given with such notice; nursing facility required to say how much time the Appellant has to request an appeal.
Category: At Issue in Fair Hearing
Appeal 1401492
Fair Hearing Rehearing Decision 1401492
Rehearing: MassHealth was correct in determining that the appellant’s assets exceed the limit for MassHealth Standard long term care benefits; MassHealth was correct in its determination there was an impermissible transfer of assets.
Appeal 1402367
Appellant received a notice which stated, incorrectly under the law, that she had 14 days to appeal and that the nursing facility could potentially discharge her within five days after an adverse decision from the Board of Hearings. The nursing facility’s intention to give this information is likely an attempt to comply with 130 CMR 456.701(C)(5); however the actual time frames given on that notice are legally incorrect; also nursing facility failed to give reasonable and appropriate notice of non-payment prior to issuing the discharge notice.
Appeal 1216920
Community spouse refused to disclose her assets (assets held by her individually); community spouse had assigned to MassHealth the institutionalized spouse’s rights to support; community spouse’s responsibility to disclose assets held individually is waived if the institutionalized spouse’s right to support from the community spouse has been assigned to the state; MassHealth ordered to proceed with substantive determination of eligibility.
Appeal 1215370
Husband’s purchase of an annuity resulted in a transfer of resources for less than fair market value; the Commonwealth is not a remainder beneficiary of this annuity; the regulations plainly allow MassHealth to consider as disqualifying any actions taken by either the applicant or his or her spouse, and, as part of this, to require that annuities purchased by a community spouse comport with the provisions of 130 CMR 520.007(J)(2); the annuity here does not meet those regulatory requirements.
Appeal 1217117
MassHealth determined that appellant’s income flow from the 10-year fixed period annuity is less than it should be based on her life expectancy of 7.59 years; because the current monthly annuity payments do not satisfy 130 CMR 520.007(J)(1) there is a disqualifying transfer of assets; over appellant’s life expectancy she has been and will continue to receive a total of $2051.12 less than the value of the premium paid; $2051.12 represents a disqualifying transfer.
Appeal 1204083
Transfer took place before look-back period; delivery of deed took place in 2005 even though only recorded in 2009; deed executed in 2005 and appellant told granddaughters that it was in safe deposit box; since 2005 granddaughters have maintained property and acted as owners.
Appeal 1209592
Exceptional circumstances; the expenses presented by the appellant’s spouse included costs for assisted living effective January 2012; an adjustment was made to accommodate the special support service that the community spouse needed at the assisted living facility; increased MMMNA.
Appeal 1203132
The annuity as initially presented, naming the appellant’s spouse as the remainder beneficiary in the first position, does satisfy the MassHealth regulations and is acceptable to MassHealth; through a notice dated April 11, 2012 MassHealth approved the appellant’s LTC application effective December 2, 2011 as requested by the nursing facility.
Appeal 1209222
Nursing facility has valid grounds to discharge the appellant per its notice dated April 2, 2012; met its burden of providing sufficient preparation and orientation to the resident to ensure safe and orderly discharge; nursing facility actively involved the appellant in selecting the discharge location when the representatives met with the appellant and discussed possible discharge locations.
MassHealth Appeals 