2345 Undue Hardship Provision for ABD Medicaid | Medicaid

“Health or life would be endangered” means: A medical doctor with knowledge of the A/R’s medical condition at the time of the application of the penalty period, certifies in writing that in his or her professional opinion, the A/R will be in substantial danger of death or the A/R’s health will suffer substantial and irreparable harm.

“Other necessities of life” means: Basic, life sustaining utilities, including water, heat, electricity, phone, and other items or activities that without which the individual’s health or life would be endangered.

the application of a transfer of assets penalty merely inconveniences or restricts the lifestyle of the A/R

the institutionalized spouse has transferred his/her assets to the community spouse and the community spouse refuses to cooperate in making the assets available to the institutionalized spouse

the A/R’s total available income and assets (or if a couple, the total combined available income and assets of the A/R and the A/R’s spouse, or if under age 18, the combined available assets and income of the A/R and the A/R’s parents), including all countable and excluded income and assets, are sufficient to provide the A/R medical care and food.

Clothing, shelter, and other necessities of life such that the A/R’s health or life would NOT be endangered

An institutionalized spouse who has excess resources will not be found ineligible for Medicaid where it is determined that denial of eligibility on the basis of having excess assets would create undue hardship.

An individual for whom receipt of distribution from a Medicaid qualifying trust would cause ineligibility will not be found ineligible for Medicaid where it is determined that such denial would create undue hardship to the A/R.

An individual having transferred assets for less than the fair market value, or having transferred assets into a trust, will not be found ineligible for Medicaid nursing facility services or home and community-based services where it is determined that such denial would create undue hardship to the A/R.

Generate a system notice (timely if review) and a separate Undue Hardship Waiver letter, found in Appendix F,

within that initial 12 days, DFCS provides, in writing, the “Undue Hardship Waiver Application” form and information to apply for undue hardship

if an additional 12 days is needed to obtain information, the A/R, representative or facility must request prior to the end of the initial 12 days

once the undue hardship waiver is decided, the MES has 12 days in which to notify the A/R, representative and facility of the outcome.

If the undue hardship waiver is approved, reopen the case if it was denied/closed, waiving the penalty, beginning with the month of the application for the waiver or the month in which all information and documentation is provided to make the waiver determination, whichever is later. Do not waive notice.

If the undue hardship waiver is denied or if at the end of the allotted time periods, the undue hardship waiver has not been submitted by the A/R, representative or facility, another denial/closure notice must be sent. Close or activate transfer if case has been left open. If the case was already closed/denied, notify the AR in writing of the denial. The notice of the penalty to the A/R must include a statement that undue hardship was considered and determined not to be applicable. The A/R may still request a hearing under the normal hearing process (either via system or manual letter). These hearings will be handled by the Department of Human Resources Legal Services Office. Refer to Appendix B OSAH Responsibilities.

document which of the three conditions is met.

document how the condition is met including why the individual will suffer irrevocable harm if denied Medicaid.

Document date request received, date when MES responded and whether the request was written or oral.