- Appellant’s long-term care application denied because MassHealth determined there had been a disqualifying resource transfer (this resulted in an ineligibility period). The transfer was an annuity which was a private, inter-family, unsecured agreement found to be disqualifying.
Category: Tewksbury
Appeal 1601813
- MassHealth approved appellant for long-term care benefits and established a PPA but the appellant’s community spouse is appealing for an increase based upon significant financial duress arising from exceptional circumstances. Appeal denied.
Appeal 1513371
The patient paid amount charged for May 2015 is incorrect; and therefore, the amount the nursing facility asserts that Appellant owes is also incorrect.
Appeal 1511917
Community spouse has not shown significant financial duress resulting from exceptional circumstances arising from her own medical condition, frailty, or similar special needs; regulations do not allow for the consideration of an institutionalized spouse’s outstanding bills in determining whether exceptional circumstances exist to warrant an increase in the SMND.
Appeal 1404097
The HR Realty Trust is in fact revocable by appellant because she is the Settlor, regardless of her resignation as Trustee; appellant and her late husband removed the property from the HR Trust on May 20, 2004, and deeded the property back to themselves as tenants by the entirety so that they could obtain a mortgage; home is countable asset.
Appeal 1209592
Exceptional circumstances; the expenses presented by the appellant’s spouse included costs for assisted living effective January 2012; an adjustment was made to accommodate the special support service that the community spouse needed at the assisted living facility; increased MMMNA.
Appeal 1200340
MassHealth determined that the appellant transferred assets when she paid her son and daughter-in-law for services under a personal care contract; compensation for a variety of personal services; the services she received were not worth the $48,550 that she paid but did have some value; remanded for MassHealth to redetermine the period of ineligibility.
Appeal 1107446
No evidence presented to show that the appellant received fair market value at the time she made the transfers to her son; the payments were done in advance of the services being provided by the appellant’s son; there was no testimony or evidence to demonstrate that this is a typical practice of property management; it is difficult to conclude that the transfers were made exclusively for a purpose other than to qualify for MassHealth when the appellant demonstrated that a contract was entered into after entering a facility and payments were made in advance of services being provided.
Appeal 1104896
Adjust the MMMNA to account for the community spouse’s assisted living costs and adjustment to the SMNA; exceptional circumstances exist; an adjustment shall be made to accommodate the special support service that the community spouse needs at the assisted living facility; community spouse’s gross income is less than what she needs to meet the expenses caused by the exceptional circumstances.
Appeal 0809900
The caregiver agreement entered into by appellant’s daughter in her capacity as appellant’s power-of-attorney, and appellant’s son as caregiver, is a disqualifying transfer of assets; less than fair market value; no acceptable tangible evidence that appellant received an assisted living level of care in her son’s home.
MassHealth Appeals 