Notice is deficient in that it indicates the intention to discharge Appellant to her former home to live with her son. Appellant was admitted to the nursing facility with a diagnosis of Alzheimer’s disease and was clinically determined to require skilled nursing services; the only safe and appropriate setting for Appellant would be another skilled nursing facility capable of meeting the needs of a resident with Alzheimer’s disease. Accordingly, the subject 30-Day Notice of Intent to Discharge fails to indicate a safe and appropriate discharge location.
Category: Taunton
Appeal 1118365
Transfer of $36,000.00 was made exclusively for a purpose other than to qualify for MassHealth and therefore not a disqualifying transfer; Appellant transferred to her grandchildren a gift of $12,000.00 each; Appellant did so relying on tax advice and in an attempt to ease the financial burden of her grandchildren; at the time of the transfer the Appellant was 83 years old and although she had a number of medical issues she was in reasonably good health and there is no evidence that she transferred the funds with the knowledge that she would be entering a nursing home in 2010 or with the intent to establish eligibility for MassHealth benefits in 2011.
Appeal 1112754
Transfers to appellant’s son of $551,466.94 from appellant’s bank accounts between 6/20/08 and 5/12/10 as well as the payment of $107,433.98 to the son from proceeds of the sale of appellant’s residence on 12/01/10 are disqualifying transfers of a total of $658,900.92; there is no evidenced benefit received by appellant or her spouse for the transfer of $658,900.92 to the son over a two year period; the multiple transfers of money constitute outright gifts and thus multiple disqualifying transfers.
Appeal 1019516
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.
Appeal 1009905
Appellant’s withdrawal is a disqualifying transfer; intent and lack of fair market value consideration; appellant had intent to qualify for MassHealth because she was in declining health at the time of the transfer, evidenced by the sale of her home and the need to enter an assisted living center.
Appeal 1010857
Appellant had been in the nursing home nearly 4 months when $36,312.50 was withdrawn from her Seamen’s account to “pay” her friend and attorney-in-fact “for services rendered pursuant to the DPOA”. MassHealth considered the money a gift and thus, a disqualifying transfer; no written agreement to pay for any services rendered; JK was acting as appellant’s trusted friend and there was no agreement that she would be paid to provide any personal care services within or outside of the four corners of the DPOA; the activities provided by JK for appellant do not have an ascertainable fair-market value.
Appeal 1009605
Community spouse has gross monthly income of $1,061.50 and MassHealth has calculated an MMMNA of $2,191.00; regulations dictate MassHealth consider the institutionalized spouse’s income for the community spouse when there is a shortfall between the community spouse’s income and the MMMNA; appellant or institutional spouse has income of $1,628.52 (after subtraction of the appellant’s health insurance of $113.20 and his personal needs allowance of $72.80); community spouse retains $1,129.50 of the institutional spouse income to meet the MMMNA; the PPA is correct.
Appeal 1004772
Although MassHealth’s calculation was correct using the life expectancy table that it did, it was incorrect to ignore the appellant’s life expectancy table from Aviva; MassHealth was presented with a copy of the Aviva table and, without sufficient justification, refused to apply it; this is not acceptable, as a life expectancy table from an annuity company cannot be disregarded for the sole reason that it affords a better outcome for a client; rather it must be afforded “due weight.”
Appeal 1007332
Community spouse refused to cooperate; appellant submitted assignment of spousal support rights to MassHealth; appellant entitled to determination of eligibility.
Appeal 1000302
Community spouse resides in assisted living facility; monthly fee of $4,775.00 covers rent, meals, heat, hot water and electricity; no duplication of expenses by eliminating the MMMNA calculation and applying the assisted living monthly fee so that the community spouse can continue to reside in the assisted living facility; exceptional circumstances.
MassHealth Appeals 