Reason for planned discharge not supported by documentation of testimonial evidence; facility did not demonstrate that appellant’s behavior endangers others; documentation provided by facility does not support reason for discharge; at the hearing the facility did not address the discharge plan to the shelter nor did it provide information about how appellant could be cared for in the community setting.
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.
MMMNA not increased; no exceptional circumstances; spouse did not incur any extraordinary expenses arising from her own medical conditions.
Appellant suffers from medical conditions that cause her to incur high out-of-pocket expenses; these expenses cause financial distress; these medical issues plus financial distress constitute exceptional circumstance; MMMNA increased and patient paid amount decreased.
Appellant purchased annuity; was not disqualifying transfer because it occurred before the look-back period.
Community spouse resides in assisted living facility; monthly fee includes heat, hot water, electricity, meals, and health insurance premium; hearing officer concluded no duplication of expenses by eliminating the MMMNA calculation and applying the actual costs associated with residing in the facility, so that spouse could continue to reside in facility.
Community spouse did not meet exceptional circumstances criteria for increased Spousal Maintenance Needs Allowance; spouse said she needed an increase to cover two mortgages, heat, light, and credit card bills; but federal standards used when calculated MMMNA already covers utilities, shelter, and other day-to-day expenses so these are not exceptional circumstances.
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.
Transfer of $43,000 was for less than fair market value and was not for purpose other than to qualify for MassHealth; Appellant claimed it was for repayment for work performed on Appellant’s home but no evidence was presented to establish this fact.