- Denied initially because assets were determined to exceed the limit for MassHealth. In appeal, out-of-state real estate held in the appellant’s spouse’s name is determined to be inaccessible and non-countable at this time. Therefore, appellant is eligible for MassHealth.
Category: Approval
Appeal 1512837
Appellant will now be given the June 4, 2015 start date she is seeking; no longer a disqualifying transfer issue; additional information received from Appellant’s side related to Appellant’s reverse mortgage.
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 1503799
No disqualifying transfer; remainder interest in property was transferred to appellant’s sons in 2004; appellant retained life estate; deed mistakenly not recorded and only recorded in 2015; testimony from family, lawyers, and legal staff; copy of unrecorded 2004 deed; no evidence to suggest illegal backdating of document.
Appeal 1501589
Appellants have failed, after reasonable and appropriate notice, to pay for or have a third party pay for their stay at the facility and thus may be discharged; however, the facility has not provided sufficient preparation and orientation to Appellants to ensure safe and orderly transfer or discharge from the facility to another safe and appropriate place.
Appeal 1500851
Appellant issued a check to her granddaughter for $17,900; written codification was entered into after the services were rendered, and Appellant did not make contemporaneous payments for the services; Appellant’s granddaughter testified that she did not perform the services for free; rather, she agreed to perform the services and Appellant agreed to compensate her granddaughter at a later date; presented contemporaneous logs as well as the written codification of the agreement signed by Appellant; rebutted the presumption that the services were intended to be provided without compensation.
Appeal 1412045
Community spouse refused to provide information about her assets; appellant has assigned to MassHealth right to support from the community spouse.
Appeal 1410160
Appellant must have “sufficient preparation and orientation to ensure a safe and orderly transfer to another safe and appropriate place”; the record strongly suggests that the appellant’s previous place of residence, shared with her son, is not a “safe and appropriate place.”
Appeal 1407261
Even though the facility has provided notice of an outstanding balance, it is premature to conclude that there has been a failure to pay while Appellant’s MassHealth application remains open; no evidence in the record to show that the residence is a safe and appropriate place for Appellant, nor evidence that the facility has provided sufficient preparation and orientation to Appellant to ensure a safe and orderly discharge to the residence.
Appeal 1409486
No adequate and acceptable documentation in the clinical record, from the resident’s physician, signing off on and attesting to the statement that this Appellant’s health has improved sufficiently enough to make the discharge appropriate; nursing facility has already failed twice in trying to serve Appellant with proper and appropriate notices; while the nursing facility is free to make another attempt, the nursing facility is strongly encouraged to review the applicable law and regulations quoted within this decision, and make sure that its notice, discharge planning, and paperwork prepared for hearing comply with all the regulatory law and the requirements given by the Board of Hearings.
MassHealth Appeals 