Spouse needed to live in assisted living facility due to medical problems; exceptional circumstances resulting in financial duress; MMMNA increased.
Category: Patricia Mullen
- Issue is whether MassHealth was correct in determining that the appellant’s income exceeds the limit for MassHealth Standard for persons age 65 and older. Appeal denied.
Appellant suffers from medical conditions for which she incurs out-of-pocket expenses; appellant’s only income is her spousal allowance; expenses result in significant financial distress; exceptional circumstance exists.
Notice of discharge meets regulatory requirements; nursing facility involved appellant and his guardian in discharge planning; fact that appellant has not found place he wants to live is out of control of nursing facility; physician indicated appellant medically cleared for discharge; place to which appellant will be discharged is safe and appropriate.
- Issue is whether MassHealth was correct in determining that the appellant’s spouse’s assets exceed the limit for MassHealth. Other issue is whether the appellant is allowed to retain the excess assets in order to meet her MMMNA. Appeal is approved.
- Issue is whether MassHealth was correct in determining the appellant’s PPA to the nursing facility. Other issue is whether the appellant’s spouse is entitled to an increased spousal allowance to help pay for a needed stay in an assisted living facility. Appeal is approved.
- Issue is whether MassHealth was correct in determining that the appellant transferred an amount for less than fair market value resulting in a MassHealth ineligibility period. Appeal denied.
- MassHealth denied the appellant’s application. Ordered to re-determine eligibility based on the determination that the excess asset amount is now $0 after a shift of excess assets to the community spouse to help pay for a necessary stay in assisted living.
- Issue is whether MassHealth was correct in determining the appellant’s PPA to the nursing facility. MassHealth ordered to modify their calculations based on specific determinations.
- Appellant denied for MassHealth Standard benefits for LTC residents because MassHealth determined that the appellant transferred assets for less than fair market value resulting in a period of ineligibility. Appeal denied.