Exceptional circumstances present; community spouse has exceptional care needs; MMMNA increased to cover necessities that arise from his medical condition; community spouse also entitled to keep all institutionalized spouse’s income and excess assets.
Category: Cynthia Kopka
Appeal 1806447
Spouse argued her net income, not gross income, should be considered; MassHealth may only consider gross income in determining whether she is entitled to SMND; as gross income is higher than MMMNA, she is not entitled to an SMND; increase in MMMNA not warranted because did not meet extraordinary circumstances test; utilities, groceries, car payments, cable, and phone not extraordinary circumstances.
Appeal 1708238
- Issue is whether MassHealth was correct in determining that Appellant made disqualifying transfers during the look-back period and in calculating the period of ineligibility. MassHealth ordered to adjust the total amount of the disqualifying transfer and to redetermine the period of disqualification in accordance with the adjusted impermissible transfer figure.
Appeal 1703276
Fair Hearing Decisions 1703276
- Issue is whether MassHealth was correct in determining that Appellant’s assets exceed MassHealth’s limits. Appeal denied.
Appeal 1702226
- Appeal is whether MassHealth was correct in determining that Appellant made disqualifying transfers during the look-back period and in calculating the period of ineligibility. MassHealth ordered to adjust the total amount of the disqualifying transfer to reflect the amount determined permissible and the amount of the partial cure. Then ordered to redetermine the period of disqualification in accordance with the adjusted impermissible transfer figure.
Appeal 1501589
Appellants have failed, after reasonable and appropriate notice, to pay for or have a third party pay for their stay at the facility and thus may be discharged; however, the facility has not provided sufficient preparation and orientation to Appellants to ensure safe and orderly transfer or discharge from the facility to another safe and appropriate place.
Appeal 1500851
Appellant issued a check to her granddaughter for $17,900; written codification was entered into after the services were rendered, and Appellant did not make contemporaneous payments for the services; Appellant’s granddaughter testified that she did not perform the services for free; rather, she agreed to perform the services and Appellant agreed to compensate her granddaughter at a later date; presented contemporaneous logs as well as the written codification of the agreement signed by Appellant; rebutted the presumption that the services were intended to be provided without compensation.
MassHealth Appeals 