PARTIAL APPROVAL OF UNDUE HARDSHIP WAIVER REQUEST NOTICE TEXT-LTC ASSET TRANSFERS
Until automated notices are available the following text and citations should be printed on the manual notice sent to the individual in the LTC facility as well as all involved parties, informing them that the undue hardship waiver was partially granted:
You previously received a notice stating you would not qualify for payment of
Long Term Care (LTC) facility services for a certain time period because you gave
away or transferred assets for less than fair market value (FMV). You requested
an undue hardship waiver. Payment of LTC facility services has been approved for
part of this time period. Because you gave away or transferred a total of
$_____ in assets for less than FMV you are not eligible for payment towards
the cost of LTC facility services beginning on _____ and ending on
_____. During this time, you will need to pay the LTC facility for the services
that you are given. You are eligible for all other Medical Assistance benefits. You
may qualify for payment of LTC facility services after this period.
Citations: 42 U.S.C. § 1396p(c), 55 Pa. Code 178.104b, 181.452 and 181.453
PARTIAL APPROVAL OF UNDUE HARDSHIP WAIVER REQUEST NOTICE TEXT-HCBS ASSET TRANSFERS
Until automated notices are available the following text and citations should be printed on the manual notice sent to the individual requesting payment of HCBS as well as all involved parties, informing them that the undue hardship waiver was partially granted:
You previously received a notice stating you would not qualify for payment of
Home and Community Based Services (HCBS) for a certain time period because
you gave away or transferred assets for less than fair market value (FMV). You
requested an undue hardship waiver. Payment of HCBS has been approved for
part of this time period. Because you gave away or transferred a total of
$_____ in assets for less than FMV you are not eligible for payment towards
the cost of HCBS beginning on _____ and ending on _____. During this
time, you will need to pay the HCBS provider for the services that you are
given. You are eligible for all other Medical Assistance benefits. You may qualify
for payment of HCBS after this period.
Citations: 42 U.S.C. § 1396p(c) and 55 Pa. Code § 178.104b
Issued March 12, 2012