Disqualifying transfer of $53,703 after appellant sold her home and deposited the proceeds into her grandson’s checking account; grandson cured a portion of this transfer and the ineligibility period was revised; no documentation to support grandson’s claim that he paid appellant’s expenses out of the proceeds from the home sale due to the insufficiency of her income to make ends meet; hearing officer concluded transfer was gift with no fair market value compensation received in return; also concluded there was intent to qualify for MassHealth.
Category: Denial
Appeal 1806447
Spouse argued her net income, not gross income, should be considered; MassHealth may only consider gross income in determining whether she is entitled to SMND; as gross income is higher than MMMNA, she is not entitled to an SMND; increase in MMMNA not warranted because did not meet extraordinary circumstances test; utilities, groceries, car payments, cable, and phone not extraordinary circumstances.
Appeal 1806786
- Issue is whether MassHealth was correct in determining that appellant’s ownership interest in jointly-held stocks are accessible assets, and therefore countable to appellant in a MassHealth eligibility determination. Appeal is denied.
Appeal 1806752
- Appellant denied because he has more countable income than MassHealth benefits allows (even with a PCA disregard). Therefore, he does not meet MassHealth eligibility requirements.
Appeal 1800614
Appellant transferred $13,858 for less than fair market value; ineligibility period of 40 days; eleven transfers made to appellant’s daughter while she was resident in nursing facility knowing she would need funds to provide for her care; daughter could not show evidence that transfers were reimbursements for money she had spent on behalf of appellant.
Appeal 1805122
Transfer of $43,000 was for less than fair market value and was not for purpose other than to qualify for MassHealth; Appellant claimed it was for repayment for work performed on Appellant’s home but no evidence was presented to establish this fact.
Appeal 1717185
- Issue is whether Appellant is entitled to an adjustment to the PPA where his spouse was living in an assisted living facility. Appeal denied.
Appeal 1805351
Community spouse did not meet exceptional circumstances criteria for increased Spousal Maintenance Needs Allowance; spouse testified she needed an increase to cover day-to-day bills and to assist her adult disabled child; regulations only allow increase where needs arise from medical condition, frailty, or similar special needs of the community spouse.
Appeal 1804208
No exceptional circumstances; testified only to normal expenses such as rent and utilities; only medical expenses were co-pays.
Appeal 1805159
Appellant discharged from nursing facility to homeless shelter; discharge was warranted; location of discharge approved by appellant’s physician; appellant does not need services of skilled nursing facility.
MassHealth Appeals 