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

V. UNDUE HARDSHIP DECISION

A. Approve undue hardship when:

1. The written statement from the medical doctor with knowledge of the a/r’s medical condition states that depriving the a/r’s health will suffer irreparable harm or be in danger of death if a penalty period is imposed.

Note: If the a/r is in a nursing home or hospital or a facility like ACH, and not facing discharge, then a/r’s life or health is not endangered.

And

ISSUED 11/01/07 – CHANGE NO. 24-07

(V.A.)

2. Statements from knowledgeable persons establishing through the greater weight of evidence that no other sources are available to the a/r to provide for medical care, food, clothing, shelter, or other necessities of life that are essential to the a/r’s health and life.

And

3. The a/r or person or institution acting on behalf of the a/r is making a good faith effort to pursue all reasonable means to recover the transferred asset or the fair market value of the transferred asset as described in IV.D. above.

B. Deny undue hardship when:

1. The a/r or some other person or facility acting on the a/r’s behalf fails to provide information and documentation in the time allowed or fails to fully cooperate.

2. The a/r or some other person or facility acting on the a/r’s behalf fails to make a good faith effort to recover the transferred asset as described in IV.D. above.

3. The a/r or a/r’s spouse only provide proof that they cannot maintain their existing life style or the undue hardship only causes an inconvenience.

4. The a/r’s total available assets (or if a couple, the total combined available assets of the a/r and the a/r’s spouse, or if under age 18, the combined available assets of the a/r’s parents), including all countable and excluded assets except as determined in IV.C. above, are sufficient to provide the a/r medical care, food, clothing, shelter, and other necessities of life.

5. The a/r has transferred income and/or assets to the community spouse and the community spouse refuses to cooperate in making the assets available to the a/r.

C. If it is determined that an undue hardship exists, waive the penalty period and notify the a/r, the a/r’s spouse or representative, or the institution acting on the a/r’s behalf. Approve the application provided all other requirements are met. Send a manual DSS-8108/DSS-8108s, Notice of Benefits, stating approval for the request for undue hardship for Medical Assistance coverage of institutional services because the a/r demonstrated that denial of payment for these services will cause an undue hardship.

ISSUED 11/01/07 – CHANGE NO. 24-07

(V.)

D. If it is determined that an undue hardship does not exist, deny the request for the waiver. Send a manual DSS-8109/DSS-8109s, Your Application for Benefits are Being Denied or Withdrawn, stating denial of the request for undue hardship for Medical Assistance coverage of institutional services and the reason for the denial. Impose the transfer of asset penalty sanction.