Health insurance premiums are not an extraordinary uncovered medical expense as the very nature of health insurance is that it covers certain medical services, thus insurance in and of itself would never be a covered medical expense; the MassHealth regulation only allows an increase to the MMMNA for exceptional circumstances as outlined in the above regulation and such circumstances do not include high shelter costs, unless the shelter cost is related to the community spouse’s medical condition as in the case of an assisted living resident.
Category: Taunton
Appeal 1505979
The MassHealth regulation only allows an increase to the MMMNA for exceptional circumstances as outlined in the regulation and such circumstances do not include shelter costs, unless the shelter cost is related to the community spouse’s medical condition as in the case of an assisted living resident; the community spouse is 58 years old and there is no evidence of a medical condition that results in high out of pocket medical expenses; community spouse does not have extraordinary uncovered medical expenses arising from her medical condition that result in significant financial duress.
Appeal 1503799
No disqualifying transfer; remainder interest in property was transferred to appellant’s sons in 2004; appellant retained life estate; deed mistakenly not recorded and only recorded in 2015; testimony from family, lawyers, and legal staff; copy of unrecorded 2004 deed; no evidence to suggest illegal backdating of document.
Appeal 1500851
Appellant issued a check to her granddaughter for $17,900; written codification was entered into after the services were rendered, and Appellant did not make contemporaneous payments for the services; Appellant’s granddaughter testified that she did not perform the services for free; rather, she agreed to perform the services and Appellant agreed to compensate her granddaughter at a later date; presented contemporaneous logs as well as the written codification of the agreement signed by Appellant; rebutted the presumption that the services were intended to be provided without compensation.
Appeal 1409043
Appellant-wife submitted no evidence to substantiate her claim that she has unusual medical expenses constituting the “exceptional circumstances” that would justify an increase in the SMND when calculating the appellant-husband’s PPA.
Appeal 1406406
Transfers were for less than fair market value; appellant’s brother did not possess a present life estate interest in the trust; the amount transferred to him upon the sale of the property was a disqualifying transfer.
Appeal 1401492
Fair Hearing Rehearing Decision 1401492
Rehearing: MassHealth was correct in determining that the appellant’s assets exceed the limit for MassHealth Standard long term care benefits; MassHealth was correct in its determination there was an impermissible transfer of assets.
Appeal 1402367
Appellant received a notice which stated, incorrectly under the law, that she had 14 days to appeal and that the nursing facility could potentially discharge her within five days after an adverse decision from the Board of Hearings. The nursing facility’s intention to give this information is likely an attempt to comply with 130 CMR 456.701(C)(5); however the actual time frames given on that notice are legally incorrect; also nursing facility failed to give reasonable and appropriate notice of non-payment prior to issuing the discharge notice.
Appeal 1217117
MassHealth determined that appellant’s income flow from the 10-year fixed period annuity is less than it should be based on her life expectancy of 7.59 years; because the current monthly annuity payments do not satisfy 130 CMR 520.007(J)(1) there is a disqualifying transfer of assets; over appellant’s life expectancy she has been and will continue to receive a total of $2051.12 less than the value of the premium paid; $2051.12 represents a disqualifying transfer.
Appeal 1203132
The annuity as initially presented, naming the appellant’s spouse as the remainder beneficiary in the first position, does satisfy the MassHealth regulations and is acceptable to MassHealth; through a notice dated April 11, 2012 MassHealth approved the appellant’s LTC application effective December 2, 2011 as requested by the nursing facility.
MassHealth Appeals 