Trust cannot be considered countable asset; MassHealth counted $16,000 held in a revocable trust established by the spouse who is now deceased; spouse’s will left estate to appellant; appellant’s attorney currently unable to find someone willing to be trustee (terms of trust require corporate trustee with 50 years management experience); upon spouse’s death assets are supposed to be divided into two trusts; appellant is only beneficiary of one of them; amount to be distributed to marital trust if any is the minimum amount that would allow the trust to qualify for the federal estate tax deduction; amount to be distributed unknown and could be as little as nothing.
Facility did not provide appellant with sufficient preparation and orientation to ensure a safe and orderly discharge from the facility to another safe and appropriate place; facility did not designate a discharge location; clinical record lacks progress note from physician to document he no longer needs the facility’s services; no progress note by physician documenting appellant’s danger to safety of other residents.
Spouse needed to live in assisted living facility due to medical problems; exceptional circumstances resulting in financial duress; MMMNA increased.
- 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.
MMMNA was lower than what MassHealth calculated and therefore new allowable MMMNA is higher; no spousal deduction from appellant’s income because no extraordinary circumstances; medical expenses and water bill not extraordinary.
Disqualifying transfer of assets; appellant paid daughter $8,000 in consideration of a “personal service contract”; while not all personal caregiver contracts are per se disqualifying transfers for less than fair market value, here, appellant has not received ascertainable fair market value for his purchase since he was admitted to a nursing home and was already receiving hands on care in the facility; therefore the personal care services under the contract were unnecessary or duplicative.
Disqualifying transfer of $53,703 after appellant sold her home and deposited the proceeds into her grandson’s checking account; grandson cured a portion of this transfer and the ineligibility period was revised; no documentation to support grandson’s claim that he paid appellant’s expenses out of the proceeds from the home sale due to the insufficiency of her income to make ends meet; hearing officer concluded transfer was gift with no fair market value compensation received in return; also concluded there was intent to qualify for MassHealth.
Appellant transferred $13,858 for less than fair market value; ineligibility period of 40 days; eleven transfers made to appellant’s daughter while she was resident in nursing facility knowing she would need funds to provide for her care; daughter could not show evidence that transfers were reimbursements for money she had spent on behalf of appellant.
Community spouse has income amount less than MMMNA; spouse entitled to keep all of appellant’s income after PNA deduction; spouse entitled to all excess assets.
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.