Elder & Disability Law Advocates is happy to report the successful resolution of superior court litigation against MassHealth. Our clients (husband and wife), residents of the Lutheran Rehabilitation and Skilled Care Center, located at 26 Harvard Street in Worcester, Massachusetts, filed an application seeking long-term care benefits to assist them in paying for their nursing home care. In response, MassHealth issued a vague denial notice that did not adequately provide the reasons for the denial. The applicants were unable to prepare for an administrative appeal of that denial and sought judicial intervention to require that MassHealth provide a clear statement of the specific reasons why their application was denied.
After filing an action for Declaratory Judgement in Suffolk Superior Court, the court ruled that the denial notice issued to our clients’ did not provide “[a] clear statement of the specific reasons supporting the intended action” and was therefore in violation of Federal Law. In ruling that MassHealth failed to give a clear statement of the specific reason for why it deemed the asset (trust) countable, the court held that our clients lacked the information required to permit adequate preparation of the administrative appeal of the case. 130 Code Mass. Regs. 610.046(A).
The court also cited Daley v. Secretary of Executive Office of Health and Human Services, 477 Mass. 188 (2017) – a case brought before the Supreme Judicial Court by Elder & Disability Law Advocates on behalf of another client. The Suffolk Superior Court cited to Daley in saying – “We conclude that neither the grant in an irrevocable trust of a right of use and occupancy in a primary residence to an applicant nor the retention by an applicant of a life estate in his or her primary residence makes the equity in the home owned by the trust a countable asset for the purpose of determining Medicaid eligibility for long-term care benefits.”
Finally, the court goes on to say that money spent trying to discern MassHealth’s reasons for denying an application cannot be recovered by suing the agency. But that focus upon the agency’s real and stated reasons for the denial of an application allows a better opportunity to prepare, without wasting money or diluting the applicant’s efforts. The court goes on to say that is why 130 Code Mass. Regs. 610.046(A) requires sufficient notice “to permit adequate preparation of the case.”
The court recognized that “Applicants represented by counsel may save significant resources.” If you are going to file an application seeking MassHealth benefits, or have already filed an application and need representation to advocate with MassHealth, we can help. The earlier in the MassHealth process you seek legal counsel, the better. Want to learn more? Click here to contact us!