- Appellant recently gave away or sold assets to become eligible for MassHealth long term care services creating a period of ineligibility. Appeal denied.
Category: Denial
Appeal 1612965
Appeal 1604297
- Appellant purchased an annuity that lasts beyond the appellant’s life expectancy, and therefore made a disqualifying transfer of assets resulting in a period of ineligibility. Appeal denied.
Appeal 1607197
- Facility notified appellant of its intent to transfer her to a different center because she failed to pay for services rendered at the facility. Decision is to proceed with the transfer.
Appeal 1602466
- Appellant denied for MassHealth Standard benefits for LTC residents because MassHealth determined that the appellant transferred assets for less than fair market value resulting in a period of ineligibility. Appeal denied.
Appeal 1600269
- Appellant’s long-term care application denied because MassHealth determined there had been a disqualifying resource transfer (this resulted in an ineligibility period). The transfer was an annuity which was a private, inter-family, unsecured agreement found to be disqualifying.
Appeal 1601813
- MassHealth approved appellant for long-term care benefits and established a PPA but the appellant’s community spouse is appealing for an increase based upon significant financial duress arising from exceptional circumstances. Appeal denied.
Appeal 1600586
Appellant did not demonstrate by preponderance of evidence that spouse would not cooperate; no evidence of noncooperation besides appellant’s own statement in a letter.
Appeal 1601439
- Appellant failed to pay his patient paid amount so was sent a Notice of Intent to Discharge of Transfer. Records conclude that he has failed to pay for his stay at the nursing facility after reasonable and appropriate notice. Appeal denied.
Appeal 1511917
Community spouse has not shown significant financial duress resulting from exceptional circumstances arising from her own medical condition, frailty, or similar special needs; regulations do not allow for the consideration of an institutionalized spouse’s outstanding bills in determining whether exceptional circumstances exist to warrant an increase in the SMND.
MassHealth Appeals 