Appeal 1805795

Fair Hearing Decision 1805795

Daughter withdrew $119,000 from bank account she jointly owned with mother; 7 months later appellant applied for long term benefits; 336 day ineligibility period arising from daughter’s withdrawal; record was left open to allow appellant opportunity to establish why this should not be treated as a disqualifying transfer; nursing facility filed suit under contractual theory against appellant and her daughter; as appellant is not taking any action, the hearing officer concluded the matter had moved beyond the issue of MassHealth eligibility; nursing facility’s legal claim is appropriate course of action for when MassHealth coverage has been conclusively denied.

Appeal 1511917

Fair Hearing Decision 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.