The hearing officer ruled that the primary beneficiary of a spousal annuity does not have to be “Commonwealth of Massachusetts” without limiting language. Since the MassHealth regulation only allows estate recovery to the extent of MassHealth benefits correctly paid, the beneficiary language can be limited to track the regulation.
Category: Sara E. McGrath
Appeal 1813119
No increase in MMMNA warranted; community spouse has financial duress but no exceptional circumstances; past due medical bills consisting of small co-pay amounts accumulated since 2014; these are small typical charges incurred in the normal course by individuals with health insurance.
Appeal 1600586(Remand)
Fair Hearing Decision 1600586(Remand)
- Appellant denied for benefits because he did not give MassHealth the information about his spouse’s assets and income that it needed to decide his eligibility.
Appeal 1800544
Facility notified appellant of debt owed; facility provided reasonable and appropriate notice of the debt owed; appellant failed to pay; physician confirmed that 24-hour care by a home health agency will meet appellant’s needs.
Appeal 1607197
- Facility notified appellant of its intent to transfer her to a different center because she failed to pay for services rendered at the facility. Decision is to proceed with the transfer.
Appeal 1600586
Appellant did not demonstrate by preponderance of evidence that spouse would not cooperate; no evidence of noncooperation besides appellant’s own statement in a letter.
Appeal 1014765
Transfer took place before look-back period; deed was delivered to son earlier even though only recorded later; son testified and provided evidence.
Appeal 0807837
APPROVED IN PART as to the transferred resources for which appellant received fair-market value, and DENIED IN PART as to the remaining transfers; $1,000.00 transfer to appellant’s granddaughter was a disqualifying transfer; Appellant has not received something tangible with intrinsic value for this exchange; majority of receipts submitted are for normal personal expenses such as groceries, restaurants, moving-related expenses, prescription medication, doctors’ co-payments, parking for medical appointments, and clothing; reimbursement for all of these expenses is reasonable, and that appellant received fair-market value for the reimbursed funds.
MassHealth Appeals 