- 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.
MMMNA was lower than what MassHealth calculated and therefore new allowable MMMNA is higher; no spousal deduction from appellant’s income because no extraordinary circumstances; medical expenses and water bill not extraordinary.
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.
Nursing facility notified appellant that it intended to discharge her because she was a danger to others; facility did not meet the regulatory requirements related to discharge; notice from facility does not indicate that it was mailed to a designated family member; representative from agency did not clearly indicate how discharge location would be safe or appropriate for appellant.
MassHealth did not support its position that only first mortgage expenses are allowed in the MMMNA calculation; MassHealth’s action in calculating Appellant’s MMMNA without factoring in the monthly expense for the second the mortgage is arbitrary and capricious.
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.
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.
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.
- 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.