Have your MassHealth application reviewed or prepared by a lawyer whose specialty is MassHealth fair hearing appeals.

Make sure your MassHealth application is initially seen by a MassHealth eligibility worker in the best possible light, and that you are thoroughly prepared to deal with any possible denial.  If your MassHealth application is denied for some reason, Attorney Brian E. Barreira will know how to handle the problem if the Office of Medicaid has made a mistake in issuing the denial.

There are several reasons that a MassHealth application can be denied — some of them can be serious problems, but some are easy to handle, and it can be just a matter of knowing what procedures need to be followed.

The easier cases to handle involve denials for lack of verifications. It is important to appeal all such denials to maintain the maximum retroactivity of the original application. Other cases in the easier category are those involving whether spouses must cooperate in the application process, or whether the spouse would be better off by rearranging assets, or showing exceptional circumstances that would allow keeping more of the married couple’s income.

The more difficult appeals to handle involve irrevocable trusts, which are almost always denied.  Attorney Barreira makes periodic visits to the Office of Medicaid’s Board of Hearings to search for fair hearing decisions involving trusts; he then scans those decisions and puts these fair hearing decisions on irrevocable trusts online at http://IrrevocableTrust.info for elder law attorneys and consumers to be able to see; there are well over 180 decisions there as of now.

The most difficult appeals to handle involve disqualifying transfers of assets. Disqualifying transfers are essentially gifts made by a person within 5 years of applying for MassHealth, but sometimes involve transactions that are treated as though gifts had been made; examples include loans, loan repayments, payments for services to family members, investments that decline in value, late-recorded deeds, and joint purchases of homes. The unfortunate general rule in these cases is that the MassHealth applicant is essentially “guilty until proven innocent,” and if you lose the fair hearing appeal it is unlikely that a Superior Court judge would overturn the decision. Sometimes, it can be proven that those gifts were made for a good reason that did not involve MassHealth planning. Sometimes, a return of some or all of the assets can fix the problem. Sometimes, an undue hardship waiver can be obtained.

Unfortunately, if the MassHealth fair hearing appeal is lost, often the nursing home will attempt to discharge (i.e., evict) the nursing home resident for nonpayment, so it is important to have a long-term strategy in appeal cases.

Many of these issues are discussed at Attorney Barreira’s elder law blog and his MassHealth blog. One of his most popular blog posts has been 32 Things You Should Know When Applying for MassHealth to Cover Nursing Home Care in Massachusetts.

Have your possible MassHealth appeal of a fair hearing denial reviewed or handled by a lawyer whose specialty is appealing MassHealth fair hearing denials into the Massachusetts court system.

Attorney Brian E. Barreira has handled several appeals of note in the Massachusetts court system, including battling the MassHealth agency in 2000-2002 when it claimed it could not comply with the federal Medicaid law and calculate the average daily cost of nursing home (which is used in the calculation of a MassHealth ineligibility period); battling the agency in 2005-2010 when it tried to treat a failed investment as a gift; battling the agency in 2012-2013 when it tried to treat a loan repayment as a gift; and battling the agency in 2014-2017 in several cases on its routine, illegal denial of MassHealth applications that included irrevocable trusts (culminating in his oral argument before the Supreme Judicial Court in the case of the 2017 case of Daley v. Secretary of the Executive Office of Health and Human Services).

Since Attorney Barreira’s articles “An Irrevocable Grantor Trust Can Assure Eligibility for Medicaid” and “Despite Medicaid Transfer Restrictions, the Home May Still Be Kept in the Family” appeared in the prestigious Estate Planning journal in 1989-1990, he has been at the forefront of what has been occurring in the Medicaid/MassHealth field. Attorney Barreira has recently been involved in writing or reviewing and commenting on several briefs in the Massachusetts court system, including the 2017 case of Daley v. Secretary of the Executive Office of Health and Human Services, and also routinely helps other Massachusetts elder law attorneys either through referrals or behind the scenes on their cases.

Perhaps most importantly, Attorney Barreira has never lost a MassHealth case that he brought into the Massachusetts court system. Thus, evaluating whether a case has a realistic chance of winning, and whether you could be wasting time and money in appealing, is one of his strengths.

Contact us for more information or to make an appointment.

You can complete and submit this form to contact us to make an appointment in our Plymouth or Hingham offices, or you can call us at 508-747-8282, but please note that we do not offer any free initial consultations. No attorney-client relationship is formed by this message, so please do not post any personal information.