Adult Medicaid Manual MA-2245 UNDUE HARDSHIP WAIVER FOR TRANSFER OF ASSETS

III. Procedures For Requesting Undue Hardship Determination and Documentation

A. After the sanction period is established and was not rebutted, notify the a/r in writing of the sanction period and the undue hardship waiver process using DMA-5113, Notification of Right to Request an Undue Hardship Waiver (Transfer of Assets). If appropriate, also send a notice of pending Medicaid application, DMA-5098/DMA-5098S, Medicaid Application Pending.

B. The a/r must request the undue hardship waiver within 12 calendar days from the date of the DMA-5113. If the a/r does not request an undue hardship waiver within 12 calendar days from the date of the notice, impose the transfer of asset penalty. Send the appropriate notice. See MA-2240, Transfer of Assets, XIV.D.

C. The request may be made verbally or in writing.

D. Document the date of the initial request in the county record.

REVISED 11/01/11 – CHANGE NO. 17-11

(III.)

E. Send a DMA-5114, Request for Documentation for Undue Hardship Claim, within 5 work days of receipt of a request for a waiver.

1. Also send the DMA-5097/DMA-5097s, Request for Information. Document in the record the date the request is sent. Retain a copy of both the DMA-5114 and the DMA-5097. The individual has 12 calendar days from the date of the notice to provide the information/documentation.

2. If information/documentation is not received by the end of the 12 calendar day period, send a second DMA-5114, Request for Documentation for Undue Hardship Claim, and DMA-5097/DMA-5097s, Request for Information. Document in the record the date the request is sent. Retain a copy of both the DMA-5114 and the DMA-5097. Allow an additional 12 calendar days to submit the information/documentation.

3. If information/documentation is not received by the end of the second 12 calendar day period:

a. For applications, continue to hold through the end of the application processing period and if not received at that time, deny the undue hardship waiver request for failure to provide information/documentation. Send a DSS-8109/DSS-8109S, Notice of Benefits, Denied or Withdrawn, using the appropriate notice text code.

b. For individuals who already receive Medicaid coverage of institutional services, send a timely notice to the individual at the end of the second 12 calendar day period.

c. For pla recipients who apply for institutional services, send a DSS-8109/DSS-8109S, Notice of Benefits, Denied or Withdrawn, using the appropriate notice text code to deny the request for those services.

4. If information/documentation is received within the requested time period, evaluate for undue hardship. See III.G. below.

F. For Medicaid applications, when all other information to determine eligibility is received, and only the documentation for an undue hardship is needed, follow procedures in MA-2304, Processing the Application. Exclude time with a “WVR” exclusion code entry on the Date Screen in EIS. (See EIS-2400, Date Screen) Do not exclude time with “WVR” if the applicant is otherwise pla eligible.

REVISED 11/01/11 – CHANGE NO. 17-11

(III.)

G. The county director of social services or his designee makes the decision on undue hardship within 12 calendar days of receipt of the information/ documentation.

H. If the Director or Director’s designee identifies the need for additional information and/or documentation, request the additional information/ documentation. Use DMA-5114, Request for Documentation for Undue Hardship Claim, along with a DMA-5097/DMA-5097s, Request for Information. Document in the record the date the request is sent and retain a copy. The individual has 12 calendar days from the date of the notice to provide the information/documentation.

1. If the additional information/documentation is not received by the end of the 12 calendar day period, send a second DMA-5114, Request for Documentation for Undue Hardship Claim, along with a DMA-5097/DMA-5097s, Request for Information. Allow 12 additional calendar days to submit information/documentation.

2. Complete the determination within 12 calendar days of receipt of the additional information.

3. If the additional information is not received within the period described in III.H. and III.H.1. above, deny the undue hardship request as described in III.E.3.above.