Appeal 1804640

Fair Hearing Decision 1804640

Community spouse resides in assisted living facility; monthly fee includes heat, hot water, electricity, meals, and health insurance premium; hearing officer concluded no duplication of expenses by eliminating the MMMNA calculation and applying the actual costs associated with residing in the facility, so that spouse could continue to reside in facility.

Appeal 1809935

Fair Hearing Decision 1809935

Nursing facility notified appellant that it intended to discharge her because she was a danger to others; facility did not meet the regulatory requirements related to discharge; notice from facility does not indicate that it was mailed to a designated family member; representative from agency did not clearly indicate how discharge location would be safe or appropriate for appellant.

Appeal 1804884

Fair Hearing Decision 1804884

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.

Appeal 1717373

Fair Hearing Decision 1717373

  • 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.