Failure to pay facility; grounds sufficient for discharge; however, notice of intent was deficient due to lack of name of person at facility available to answer questions and assist appellant with appeal; also lack of documentation from physician.
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.
There is a sound basis to increase the MMMNA; the community spouse has medical issues which require ongoing care and him residing in an assisted living facility.
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.
MassHealth did not support its position that only first mortgage expenses are allowed in the MMMNA calculation; MassHealth’s action in calculating Appellant’s MMMNA without factoring in the monthly expense for the second the mortgage is arbitrary and capricious.
Community spouse has income amount less than MMMNA; spouse entitled to keep all of appellant’s income after PNA deduction; spouse entitled to all excess assets.
Appellant suffers from medical conditions for which she incurs out-of-pocket expenses; appellant’s only income is her spousal allowance; expenses result in significant financial distress; exceptional circumstance exists.
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 was correct in determining the appellant’s MassHealth start date. Ordered to change start date.
- 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.