Appellant’s withdrawal is a disqualifying transfer; intent and lack of fair market value consideration; appellant had intent to qualify for MassHealth because she was in declining health at the time of the transfer, evidenced by the sale of her home and the need to enter an assisted living center.
Category: At Issue in Fair Hearing
Appeal 1010857
Appellant had been in the nursing home nearly 4 months when $36,312.50 was withdrawn from her Seamen’s account to “pay” her friend and attorney-in-fact “for services rendered pursuant to the DPOA”. MassHealth considered the money a gift and thus, a disqualifying transfer; no written agreement to pay for any services rendered; JK was acting as appellant’s trusted friend and there was no agreement that she would be paid to provide any personal care services within or outside of the four corners of the DPOA; the activities provided by JK for appellant do not have an ascertainable fair-market value.
Appeal 1009605
Community spouse has gross monthly income of $1,061.50 and MassHealth has calculated an MMMNA of $2,191.00; regulations dictate MassHealth consider the institutionalized spouse’s income for the community spouse when there is a shortfall between the community spouse’s income and the MMMNA; appellant or institutional spouse has income of $1,628.52 (after subtraction of the appellant’s health insurance of $113.20 and his personal needs allowance of $72.80); community spouse retains $1,129.50 of the institutional spouse income to meet the MMMNA; the PPA is correct.
Appeal 1004772
Although MassHealth’s calculation was correct using the life expectancy table that it did, it was incorrect to ignore the appellant’s life expectancy table from Aviva; MassHealth was presented with a copy of the Aviva table and, without sufficient justification, refused to apply it; this is not acceptable, as a life expectancy table from an annuity company cannot be disregarded for the sole reason that it affords a better outcome for a client; rather it must be afforded “due weight.”
Appeal 1001130
Disqualifying transfer; delivery of deed occurred when it was recorded inside the look-back period; appellant claimed to have transferred property before look-back period but deed never recorded; appellant transferred property again in 2007 however, which she would not have been able to do if an earlier transfer had occurred; also there was not evidence of the original deed aside from a copy, nor did the closing attorney testify.
Appeal 1007332
Community spouse refused to cooperate; appellant submitted assignment of spousal support rights to MassHealth; appellant entitled to determination of eligibility.
Appeal 1000302
Community spouse resides in assisted living facility; monthly fee of $4,775.00 covers rent, meals, heat, hot water and electricity; no duplication of expenses by eliminating the MMMNA calculation and applying the assisted living monthly fee so that the community spouse can continue to reside in the assisted living facility; exceptional circumstances.
Appeal 0917330
The evidence does not support that the Contract is valid and binding or for fair market value; additionally, there is ample evidence that the transfer was not done exclusively for a purpose other than to qualify for MassHealth; no evidence to support the claim that appellant received care 24/7 from 2003 through to her admission in 2009 that could account for the total amount transferred in the period of that time the transfers occurred.
Appeal 0907978
The expenses presented by the community spouse included uncovered medical expenses incurred due to her heart and other medical conditions; an adjustment was made to accommodate the medical conditions and special needs of the community spouse.
Appeal 0903166
The care agreement is an enforceable contract supported by more than adequate consideration – namely, the earnings the daughter forewent; daughter left her job and gave up far greater earnings and earning potential to stay home with appellant and care for her; Appellant has demonstrated that she received fair-market value for the monies paid to her daughter under the agreement; the daughter was essentially a full-time, live-in care giver.
MassHealth Appeals 