Nursing facility’s notice simply does not comply with many requirements of Massachusetts law; nowhere in the notice is the specific name of the contact person at the facility given; the address of an appropriate legal services offices be given with such notice; nursing facility required to say how much time the Appellant has to request an appeal.
Category: Approval
Appeal 1402367
Appellant received a notice which stated, incorrectly under the law, that she had 14 days to appeal and that the nursing facility could potentially discharge her within five days after an adverse decision from the Board of Hearings. The nursing facility’s intention to give this information is likely an attempt to comply with 130 CMR 456.701(C)(5); however the actual time frames given on that notice are legally incorrect; also nursing facility failed to give reasonable and appropriate notice of non-payment prior to issuing the discharge notice.
Appeal 1216920
Community spouse refused to disclose her assets (assets held by her individually); community spouse had assigned to MassHealth the institutionalized spouse’s rights to support; community spouse’s responsibility to disclose assets held individually is waived if the institutionalized spouse’s right to support from the community spouse has been assigned to the state; MassHealth ordered to proceed with substantive determination of eligibility.
Appeal 1204083
Transfer took place before look-back period; delivery of deed took place in 2005 even though only recorded in 2009; deed executed in 2005 and appellant told granddaughters that it was in safe deposit box; since 2005 granddaughters have maintained property and acted as owners.
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 1203132
The annuity as initially presented, naming the appellant’s spouse as the remainder beneficiary in the first position, does satisfy the MassHealth regulations and is acceptable to MassHealth; through a notice dated April 11, 2012 MassHealth approved the appellant’s LTC application effective December 2, 2011 as requested by the nursing facility.
Appeal 1117214
Notice is deficient in that it indicates the intention to discharge Appellant to her former home to live with her son. Appellant was admitted to the nursing facility with a diagnosis of Alzheimer’s disease and was clinically determined to require skilled nursing services; the only safe and appropriate setting for Appellant would be another skilled nursing facility capable of meeting the needs of a resident with Alzheimer’s disease. Accordingly, the subject 30-Day Notice of Intent to Discharge fails to indicate a safe and appropriate discharge location.
Appeal 1118365
Transfer of $36,000.00 was made exclusively for a purpose other than to qualify for MassHealth and therefore not a disqualifying transfer; Appellant transferred to her grandchildren a gift of $12,000.00 each; Appellant did so relying on tax advice and in an attempt to ease the financial burden of her grandchildren; at the time of the transfer the Appellant was 83 years old and although she had a number of medical issues she was in reasonably good health and there is no evidence that she transferred the funds with the knowledge that she would be entering a nursing home in 2010 or with the intent to establish eligibility for MassHealth benefits in 2011.
Appeal 1106404
At the time of the transfer the appellant was in good health, living on her own and decided to give a gift to her daughter who was having financial difficulties; no evidence the appellant transferred the funds with the intent to apply for MassHealth 3½ years later; the transfer of $10,000.00 was for a purpose other than to qualify for MassHealth and therefore not a disqualifying transfer.
Appeal 1106530
Transfer took place before look-back period; deed was delivered to son earlier even though only recorded later; attorney testified to appellant’s earlier delivery of the deed to her son and informing him that it was a completed gift; transferred remainder interest and retained life estate.
MassHealth Appeals 