No exceptional circumstances and no significant financial duress; none of the itemized expenses arose from medical condition, frailty or similar special needs of the community spouse; the community spouse asserted monthly expenses exceeding the current MMMNA maximum by $65; the hearing officer concluded this was too small of a difference to constitute significant financial duress.
MassHealth correctly calculated community spouse’s MMMNA and appellant’s PPA; spouse had monthly medical bills of $177; hearing officer said this was not causing significant financial duress, especially given that there were other living expenses that could have been reduced in order to pay the medical bills; other expenses which community spouse wished to have covered were not necessities arising from the medical condition, frailty, or similar special needs of the community spouse.
MassHealth did not support its position that only first mortgage expenses are allowed in the MMMNA calculation; MassHealth’s action in calculating Appellant’s MMMNA without factoring in the monthly expense for the second the mortgage is arbitrary and capricious.
- Issue is whether MassHealth applied accurate facts to the controlling regulations when it denied appellant’s application for MassHealth benefits and assessed a period of ineligibility upon determining that appellant had made a disqualifying transfer of assets. MassHealth ordered to rescind denial and re-determine eligibility without any disqualifying transfer period.
No evidence that appellant made transfer with intent other than to assist a specific child in need; medical event that caused appellant’s short-term placement in skilled nursing facility was not reasonably foreseeable; intent behind transfers was not to gain MassHealth eligibility.
- Issue is whether Appellant is entitled to an adjustment to the PPA where his spouse was living in an assisted living facility. Appeal denied.
- Appellant purchased an annuity that lasts beyond the appellant’s life expectancy, and therefore made a disqualifying transfer of assets resulting in a period of ineligibility. Appeal denied.
Notice is deficient in that it indicates the intention to discharge Appellant to her former home to live with her son. Appellant was admitted to the nursing facility with a diagnosis of Alzheimer’s disease and was clinically determined to require skilled nursing services; the only safe and appropriate setting for Appellant would be another skilled nursing facility capable of meeting the needs of a resident with Alzheimer’s disease. Accordingly, the subject 30-Day Notice of Intent to Discharge fails to indicate a safe and appropriate discharge location.
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.