Nursing facility notified appellant that it intended to discharge her because she was a danger to others; facility did not meet the regulatory requirements related to discharge; notice from facility does not indicate that it was mailed to a designated family member; representative from agency did not clearly indicate how discharge location would be safe or appropriate for appellant.
Category: Susan Burgess-Cox
- Issue is whether MassHealth was correct in denying the appellant’s application for failure to provide information necessary to complete the application. The appeal is approved in part to ensure the appellant receives proper notice of the items that remain outstanding as several are either new or not clearly defined in the initial request.
- Appellant not eligible for MassHealth because she transferred assets resulting in a penalty period. MassHealth needed to adjust the ineligibility period reducing the transfer amount and provide the appellant 30 days to cure the remaining transfer amount.
Exceptional circumstances; the expenses presented by the appellant’s spouse included costs for assisted living effective January 2012; an adjustment was made to accommodate the special support service that the community spouse needed at the assisted living facility; increased MMMNA.
No evidence presented to show that the appellant received fair market value at the time she made the transfers to her son; the payments were done in advance of the services being provided by the appellant’s son; there was no testimony or evidence to demonstrate that this is a typical practice of property management; it is difficult to conclude that the transfers were made exclusively for a purpose other than to qualify for MassHealth when the appellant demonstrated that a contract was entered into after entering a facility and payments were made in advance of services being provided.
Adjust the MMMNA to account for the community spouse’s assisted living costs and adjustment to the SMNA; exceptional circumstances exist; an adjustment shall be made to accommodate the special support service that the community spouse needs at the assisted living facility; community spouse’s gross income is less than what she needs to meet the expenses caused by the exceptional circumstances.
Appellant, her husband and their daughter Rebecca and her husband Todd entered into a caregiver agreement; Appellant paid a lump sum of $50,000 in March 2007 for services that had been provided since September 2005 and were contemplated to continue to be provided for as long as possible into the unknown future; no enforcement mechanism available to appellant since the agreement could have been terminated “for whatever reason”; vague list of potential types of care to be provided with no concomitant hourly, daily, monthly or per-activity payment rate for the care; however, Appellant certainly received fair-market value for her housing and care; it was only a matter of financial circumstances that the $50,000 was not paid contemporaneously with the signing of the agreement in September 2005; thus, appellant’s payment of $50,000 to Rebecca on 3/31/07 was not a disqualifying transfer.
The value or projected payments from the appellant’s annuity is less than the value of the transferred asset (purchase price); MassHealth determined the amount of the disqualifying transfer based on the actuarial value of the annuity compared to the appellant’s life expectancy using life expectancy tables determined by MassHealth, giving due weight to the life expectancy tables of institutions in the business of providing annuities.