The recent MassHealth case involves a dispute over the eligibility of a married individual, Costa Tingos, for Medicaid long-term care benefits. Costa was in a nursing home from May 2015 until his passing in May 2020. Costa and his wife, Mary, had been married for over 50 years, but had kept their finances largely separate due to Costa’s history of gambling. Mary paid the mortgage on the family home, which was in her name, kept a steady job and Costa contributed little to the family expenses. When Costa moved into a nursing home, he applied for Medicaid benefits. However, Mary refused to provide information about her income and assets, which was necessary to determine Costa’s eligibility. Costa argued that Mary’s refusal to cooperate should not affect his eligibility.
The case was initially heard by MassHealth, which denied Costa’s application. Costa appealed to the MassHealth board of hearings, which also denied his appeal. Costa then sought judicial review in the Superior Court, which vacated the board’s decision and remanded the case back to the board. After two more rounds of hearings and appeals, the Superior Court affirmed the board’s decision to deny Costa’s application.
The court held that the board’s interpretation of the phrase “refuses to cooperate” in the relevant regulation was reasonable. The court found that Mary’s refusal to disclose her financial information did not constitute a refusal to cooperate within the meaning of the regulation, given the couple’s long history of cooperation in other aspects of their marriage. Mary was still involved in his care at the nursing home, held his power of attorney, and the couple filed joint tax returns. In practice, the applicant needs to demonstrate true estrangement, possibly including physically as well.
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