Community spouse’s total income less than MMMNA; community spouse entitled to keep all of institutionalized spouse’s income and excess assets.
No increase in MMMNA warranted; community spouse has financial duress but no exceptional circumstances; past due medical bills consisting of small co-pay amounts accumulated since 2014; these are small typical charges incurred in the normal course by individuals with health insurance.
Exceptional circumstances present; community spouse has exceptional care needs; MMMNA increased to cover necessities that arise from his medical condition; community spouse also entitled to keep all institutionalized spouse’s income and excess assets.
Nursing facility sought to discharge appellant for failing to pay; nursing facility failed to show sufficient preparation and orientation or that the discharge location is a safe and appropriate place.
Optional payments towards principal balance on home equity loan not deducted to calculate MMMNA; required minimum monthly payments are included, and MMMNA is increased accordingly.
Daughter withdrew $119,000 from bank account she jointly owned with mother; 7 months later appellant applied for long term benefits; 336 day ineligibility period arising from daughter’s withdrawal; record was left open to allow appellant opportunity to establish why this should not be treated as a disqualifying transfer; nursing facility filed suit under contractual theory against appellant and her daughter; as appellant is not taking any action, the hearing officer concluded the matter had moved beyond the issue of MassHealth eligibility; nursing facility’s legal claim is appropriate course of action for when MassHealth coverage has been conclusively denied.
Spouse argued her net income, not gross income, should be considered; MassHealth may only consider gross income in determining whether she is entitled to SMND; as gross income is higher than MMMNA, she is not entitled to an SMND; increase in MMMNA not warranted because did not meet extraordinary circumstances test; utilities, groceries, car payments, cable, and phone not extraordinary circumstances.
- Issue is whether MassHealth was correct in determining that appellant’s ownership interest in jointly-held stocks are accessible assets, and therefore countable to appellant in a MassHealth eligibility determination. Appeal is denied.
Exceptional circumstances; medically necessary for husband to reside in assisted living facility; community spouse unable to live at home due to physical limitations and need for a specialized diet; financial duress as he is residing in assisted living facility that leaves him at significant monetary shortfall each month.
- Issue is whether MassHealth applied accurate facts to the controlling regulations when it denied appellant’s application for MassHealth benefits and assessed a period of ineligibility upon determining that appellant had made a disqualifying transfer of assets. MassHealth ordered to rescind denial and re-determine eligibility without any disqualifying transfer period.