The hearing officer ruled that the primary beneficiary of a spousal annuity does not have to be “Commonwealth of Massachusetts” without limiting language. Since the MassHealth regulation only allows estate recovery to the extent of MassHealth benefits correctly paid, the beneficiary language can be limited to track the regulation.
Category: Approval
Appeal 1813276
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.
Appeal 1818021
Reason for planned discharge not supported by documentation of testimonial evidence; facility did not demonstrate that appellant’s behavior endangers others; documentation provided by facility does not support reason for discharge; at the hearing the facility did not address the discharge plan to the shelter nor did it provide information about how appellant could be cared for in the community setting.
Appeal 1813950
Community spouse’s total income less than MMMNA; community spouse entitled to keep all of institutionalized spouse’s income and excess assets.
Appeal 1816922
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.
Appeal 1810169
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.
Appeal 1811347
Appellant suffers from medical conditions that cause her to incur high out-of-pocket expenses; these expenses cause financial distress; these medical issues plus financial distress constitute exceptional circumstance; MMMNA increased and patient paid amount decreased.
Appeal 1811354
Appellant purchased annuity; was not disqualifying transfer because it occurred before the look-back period.
Appeal 1808737
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.
Appeal 1804279
Spouse needed to live in assisted living facility due to medical problems; exceptional circumstances resulting in financial duress; MMMNA increased.
MassHealth Appeals 