Appellant's Representative Daughter Case Study

In this case, the Appellant’s Representative/daughter SS submitted an exhibit which included various monthly recurring household expenses. (Exhibit C-1) The ALJ reviewed these expenses to determine if the expenses were causing financial duress for the CS. The regulations however state that the opportunity to increase the CSMNA was not to “guarantee the amenities of any current lifestyle” but rather to prevent the impoverishment of a Community Spouse. The ALJ looked at the Appellant’s verified expenses: water bill of $60.25, electric bill of $287.56, home owner’s insurance of $62.00 (stipulated by the parties; previously verified by the Department), phone bill of $231.94, real estate taxes of $124.33, gas bill of $141.29 The CS total shelter expenses were $907.37. The ALJ also considered the health insurance for the CS in the amount of $306.12 and the total prescription plan of $341.20 for both the IS and CS. The ALJ averaged the verified grocery expenses for March and April and …show more content…
The CS provided verification of a prescription plan for $170.60 per month for the IS that was not included in the calculation of the Patient Pay amount. The Appellant’s Representative SS indicated that the IS also incurred a health insurance payment of $306.15; however this expense was not verified and therefore was not used in the patient pay calculation.

Based on the above regulations and case law the ALJ finds it reasonable that the CS be granted an increase to $672.85 retroactive to January 2017 and the IS’s available income be recalculated as $1, 234.60 to include the updated medical expenses, therefore causing a subsequent reduction in the IS’s Patient Pay amount as follows:

IS Gross income $ 1,557.00 Personal Care Allowance $