For years, MassHealth has abused due process requirements in denying applications for benefits without adequately explaining the basis for the denial.   Applying for benefits has become more and more difficult and burdensome.   Finally, a Massachusetts Superior Court has acknowledged the problem and ordered MassHealth to take corrective actions.  In June of 2018, Superior Court Judge Douglas H. Wilkins entered a declaratory judgment in the consolidated cases of Maas v. Sudders (No. 18-129-D) and Hirvi v. Sudders (No. 18-845-D), ordering that MassHealth’s denial notices in cases involving trusts fail to satisfy notice requirements.  According to Federal regulation 42 C.F.R. Sec. 431.210(b), MassHealth is required to provide a “clear statement of the specific reasons supporting the intended action.”  Furthermore, Massachusetts regulations require advance written notice “to permit adequate preparation of the case.” (130 Code Mass. Reg. 610.046 (A)).

Until now, however, MassHealth denials have simply stated that the applicant has “more countable assets than MassHealth benefits allow.”   The denials do not explain how the applicant violated the referenced regulation, or how MassHealth came to its determination.   The notices rarely provide specific reasons for the denial of benefits.  As a result of this vagueness, applicants cannot take corrective action and their attorneys are not able to properly prepare for an appeal of the denial.   The vague denials are at worst an intentional effort by the agency to make it more difficult to access benefits or even assuming the best, they just reflect institutional indifference to causing unnecessary delay, costs and stress for everyone involved in the process.

 Applicants and family members faced with such denials suffer financial and psychological stresses as a result of the uncertainty.    Attorneys’ inability to adequately advise their clients ultimately results in fewer applications being approved.  In addition, it makes it more difficult to advise clients in how best to plan for future eligibility if you do not know the reasoning behind prior denials.   This practice has become so prevalent and problematic that Attorney Brian E. Barriera, who argued the Superior Court cases, was able to submit dozens of affidavits from members of the Massachusetts Chapter of the National Academy of Elder Law Attorneys recounting similar experiences with MassHealth denials in trust cases.  Although the court decision acknowledges the problem and directs MassHealth to change its ways, it unfortunately does not specify the exact approach that MassHealth must take to comply with the notice requirement.  We are optimistic that the court decision will ultimately make the eligibility process more fair and allow attorneys to effectively represent their client’s interest.  However, we know more work remains to be done.