Adjust the MMMNA to account for the community spouse’s assisted living costs and adjustment to the SMNA; exceptional circumstances exist; an adjustment shall be made to accommodate the special support service that the community spouse needs at the assisted living facility; community spouse’s gross income is less than what she needs to meet the expenses caused by the exceptional circumstances.
Category: Approval
Appeal 1014765
Transfer took place before look-back period; deed was delivered to son earlier even though only recorded later; son testified and provided evidence.
Appeal 1019516
Appellant, her husband and their daughter Rebecca and her husband Todd entered into a caregiver agreement; Appellant paid a lump sum of $50,000 in March 2007 for services that had been provided since September 2005 and were contemplated to continue to be provided for as long as possible into the unknown future; no enforcement mechanism available to appellant since the agreement could have been terminated “for whatever reason”; vague list of potential types of care to be provided with no concomitant hourly, daily, monthly or per-activity payment rate for the care; however, Appellant certainly received fair-market value for her housing and care; it was only a matter of financial circumstances that the $50,000 was not paid contemporaneously with the signing of the agreement in September 2005; thus, appellant’s payment of $50,000 to Rebecca on 3/31/07 was not a disqualifying transfer.
Appeal 1004772
Although MassHealth’s calculation was correct using the life expectancy table that it did, it was incorrect to ignore the appellant’s life expectancy table from Aviva; MassHealth was presented with a copy of the Aviva table and, without sufficient justification, refused to apply it; this is not acceptable, as a life expectancy table from an annuity company cannot be disregarded for the sole reason that it affords a better outcome for a client; rather it must be afforded “due weight.”
Appeal 1007332
Community spouse refused to cooperate; appellant submitted assignment of spousal support rights to MassHealth; appellant entitled to determination of eligibility.
Appeal 1000302
Community spouse resides in assisted living facility; monthly fee of $4,775.00 covers rent, meals, heat, hot water and electricity; no duplication of expenses by eliminating the MMMNA calculation and applying the assisted living monthly fee so that the community spouse can continue to reside in the assisted living facility; exceptional circumstances.
Appeal 0907978
The expenses presented by the community spouse included uncovered medical expenses incurred due to her heart and other medical conditions; an adjustment was made to accommodate the medical conditions and special needs of the community spouse.
Appeal 0903166
The care agreement is an enforceable contract supported by more than adequate consideration – namely, the earnings the daughter forewent; daughter left her job and gave up far greater earnings and earning potential to stay home with appellant and care for her; Appellant has demonstrated that she received fair-market value for the monies paid to her daughter under the agreement; the daughter was essentially a full-time, live-in care giver.
MassHealth Appeals 