Nursing facility sought to discharge appellant for failing to pay; nursing facility failed to show sufficient preparation and orientation or that the discharge location is a safe and appropriate place.
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.
No exceptional circumstances; testified only to normal expenses such as rent and utilities; only medical expenses were co-pays.
- Issue is whether MassHealth was correct in determining that the appellant had given away real estate in part to qualify for MassHealth benefits. Appeal denied.
Appellant properly assigned rights to support from his community spouse to MassHealth; obligation to provide asset verification was alleviated; MassHealth ordered to continue processing appellant’s application, seeking no further verifications from his ex-wife.
- MassHealth approved appellant for long-term care benefits and established a PPA but the appellant’s community spouse is appealing for an increase based upon significant financial duress arising from exceptional circumstances. Appeal denied.
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.