Transfer of resources for less than fair market value; appellant retained access to assets in irrevocable trust; trustee then distributed trust assets to children; appellant and spouse changed beneficiaries of spouse’s IRAs to children; spouse passed away 17 days later; not relevant whether trustee was exercising fiduciary duty.
No exceptional circumstances and no significant financial duress; none of the itemized expenses arose from medical condition, frailty or similar special needs of the community spouse; the community spouse asserted monthly expenses exceeding the current MMMNA maximum by $65; the hearing officer concluded this was too small of a difference to constitute significant financial duress.
MassHealth correctly calculated community spouse’s MMMNA and appellant’s PPA; spouse had monthly medical bills of $177; hearing officer said this was not causing significant financial duress, especially given that there were other living expenses that could have been reduced in order to pay the medical bills; other expenses which community spouse wished to have covered were not necessities arising from the medical condition, frailty, or similar special needs of the community spouse.
No increase in MMMNA warranted; community spouse has financial duress but no exceptional circumstances; past due medical bills consisting of small co-pay amounts accumulated since 2014; these are small typical charges incurred in the normal course by individuals with health insurance.
MMMNA not increased; no exceptional circumstances; spouse did not incur any extraordinary expenses arising from her own medical conditions.
Fair Hearing Decision 1600586(Remand)
- Appellant denied for benefits because he did not give MassHealth the information about his spouse’s assets and income that it needed to decide his eligibility.
- Issue is whether MassHealth was correct in determining that the appellant’s income exceeds the limit for MassHealth Standard for persons age 65 and older. Appeal denied.
Community spouse did not meet exceptional circumstances criteria for increased Spousal Maintenance Needs Allowance; spouse said she needed an increase to cover two mortgages, heat, light, and credit card bills; but federal standards used when calculated MMMNA already covers utilities, shelter, and other day-to-day expenses so these are not exceptional circumstances.
Disqualifying transfer of assets; appellant paid daughter $8,000 in consideration of a “personal service contract”; while not all personal caregiver contracts are per se disqualifying transfers for less than fair market value, here, appellant has not received ascertainable fair market value for his purchase since he was admitted to a nursing home and was already receiving hands on care in the facility; therefore the personal care services under the contract were unnecessary or duplicative.
Daughter withdrew $119,000 from bank account she jointly owned with mother; 7 months later appellant applied for long term benefits; 336 day ineligibility period arising from daughter’s withdrawal; record was left open to allow appellant opportunity to establish why this should not be treated as a disqualifying transfer; nursing facility filed suit under contractual theory against appellant and her daughter; as appellant is not taking any action, the hearing officer concluded the matter had moved beyond the issue of MassHealth eligibility; nursing facility’s legal claim is appropriate course of action for when MassHealth coverage has been conclusively denied.