- 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.
Category: Outcome of Fair Hearing
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 1807917
Community spouse has income amount less than MMMNA; spouse entitled to keep all of appellant’s income after PNA deduction; spouse entitled to all excess assets.
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 1801747
Appellant suffers from medical conditions for which she incurs out-of-pocket expenses; appellant’s only income is her spousal allowance; expenses result in significant financial distress; exceptional circumstance exists.
Appeal 1804884
Exceptional circumstances; medically necessary for husband to reside in assisted living facility; community spouse unable to live at home due to physical limitations and need for a specialized diet; financial duress as he is residing in assisted living facility that leaves him at significant monetary shortfall each month.
Appeal 1800903
- Issue is whether MassHealth was correct in determining the number of CSN hours and PCA hours that are medically necessary for the appellant. MassHealth ordered to remove aid pending and rescind notice. Then send notice of the authorized hours that appellant can receive.
Appeal 1714554
- Issue is whether MassHealth was correct in determining the appellant’s MassHealth start date. Ordered to change start date.
Appeal 1717373
- Issue is whether MassHealth applied accurate facts to the controlling regulations when it denied appellant’s application for MassHealth benefits and assessed a period of ineligibility upon determining that appellant had made a disqualifying transfer of assets. MassHealth ordered to rescind denial and re-determine eligibility without any disqualifying transfer period.
Appeal 1804277
Trust assets are countable; after date of notice of MassHealth ineligibility and prior to appeal hearing appellant transferred assets out of trust for a number of purposes, including to fund a pre-paid irrevocable burial arrangement, and to fund a pooled trust account in her name; transfers made to pooled trust were permissible; transfer to purchase prepaid funeral and burial was also permissible; however, 60-day clock to revise trust to comply with criteria of pooled trust begins when MassHealth issues notice of ineligibility; insufficient information for hearing officer to determine whether additional amounts transferred out of trust were permissible.
MassHealth Appeals 