Superior Court DJ on Inadequate MassHealth Notices

Hon. Douglas Wilkins

This is a declaratory judgment decision in two companion cases filed in Suffolk Superior Court, Maas v. Sudders and Hirvi v. Sudders, by 2 private attornies & members of the MA Chapter of the Natl. Assoc. of Elder Lawyers (NAELA). Each case was filed as an affirmative action seeking to enjoin a MassHealth fair hearing appealing from the denial of eligibility for Nursing Facility care based on excess assets until such time as the agency supplied a denial notice that complied with due process and state and federal law. The facts of each case involved MassHealth's decision to count assets that had been transferred into an irrevocable trust more than 5 years before as  resources still available to the member. The notice listed the amount of resources that exceeded the $2000 asset limit but contained no explanation of why the trust was being counted. The plaintiffs alleged that only at the hearing or shortly before would MassHealth disclose what provisions in the trust instrument led to the conclusion that the trust assets were still countable under the applicable Medicaid trust rules. No such information was contained in the case file. The court declined to enjoin the fair hearing or certify a class, but in a 6-22-18 decision, J. Wilkins issued a declaratory judgment that the trust notice used by MassHealth failed to contain a clear statement of the specific reason for the denial as required by law.

The Plaintiffs' lawyers report that MassHealth has developed a more specific notice but that it still lacks the required specificity, and as of Sept 2018, further proceedings are pending  to enforce the declaratory judgment.

October 2018 UPDATE. The plaintiffs' challenged a new more detailsed MassHealth notice primarily because it described its reasons as "included but not limited to" those listed.   J. Wilkins did not find the state in contempt of his June 2018 order based on that phrase alone with no evidence that there were in fact other undisclosed reasons to deny. However,  he clarified that an adequate notice must include all reasons  known to the agency at the time of its decision.   A copy of the court's Oct 11, 2018 decision is attached.