Appendix I: Eligible for MA but No Longer Eligible for LTC Notice

ELIGIBLE FOR MA BUT NO LONGER ELIGIBLE FOR LTC NOTICE TEXT- RECIPIENT ASSET TRANSFERS

Until automated notices are available the following text and citations should be printed on the manual advance notice sent to the individual in the LTC facility as well as all involved parties, informing them that the individual is no longer eligible for payment of LTC facility services:

 

Because you gave away or transferred a total of $ _____ in assets for   

less than fair market value you no longer qualify for payment of services in an

Long Term Care (LTC) facility beginning on ____ and ending on _____.

During this time period, you will need to pay the LTC facility for the LTC   

services you receive.  If you believe that the denial of the payment of LTC  

services will deprive you of medical care, food, clothing, shelter or other  

necessities of life which would endanger your health or life you may ask for 

an undue hardship waiver.                                                    

                                                                              

42 U.S.C. § 1396p(c); 62 P.S. § 441.5 and    55 Pa. Code §§ 178.104     178.104a,         

178.104b      

                                                              

 

ELIGIBLE FOR MA BUT NO LONGER ELIGIBLE FOR HCBS NOTICE TEXT-RECIPIENT ASSET TRANSFERS

Until automated notices are available the following text and citations should be printed on the manual advance notice sent to the individual receiving HCBS as well as all involved parties, informing them that the individual is no longer eligible for payment of HCBS:

 

Because you gave away or transferred a total of $_____ in assets for    

less than fair market value you no longer qualify for payment of Home and       

Community Based Services (HCBS) beginning on _____ and ending on

_____.     During this time period, you will need to pay the service provider

for the  HCBS you receive.  If you believe that the denial of the payment of HCBS

will deprive you of medical care, food, clothing, shelter or other necessities of life

which would endanger your health or life you may ask for an undue hardship

waiver.       

                                                                             

42 U.S.C § 1396p(c); 62 P.S.  §§ 441.5, 441.8 and 55 Pa. Code §§ 178.104,

178.104a, 178.104b   

     

ELIGIBLE FOR MA BUT NO LONGER ELIGIBLE FOR LTC NOTICE TEXT-EXCESS HOME EQUITY

Until automated notices are available the following text and citations should be printed on the manual advance notice sent to the individual residing in an LTC facility as well as all involved parties, informing them that the individual is no longer eligible for payment of LTC facility services:

 

Because the equity value of your home is $____ which exceeds the home 

equity limit of $____ you no longer qualify for payment of services in an  

Long Term Care (LTC) facility beginning on _____.                       

Beginning on this date, you will need to pay the LTC facility for the LTC    

services you receive.  As long as the equity value of your resident property 

exceeds $____ you will not qualify for payment of LTC services.   If you  

believe that the denial of the payment of LTC services will deprive you of   

medical care, food, clothing, shelter or other necessities of life which would

endanger your health or life you may ask for an undue hardship waiver.       

                                                                             

42 U.S.C. § 1396p(f) and 55 Pa. Code §§ 178.62a    178.104b                          

 

 ELIGIBLE FOR MA BUT NO LONGER ELIGIBLE FOR HCBS NOTICE TEXT-EXCESS HOME EQUITY

Until automated notices are available the following text and citations should be printed on the manual advance notice sent to the individual receiving HCBS as well as all involved parties, informing them that the individual is no longer eligible for payment of HCBS:

 

Because the equity value of your home is $ ____, which exceeds the home

equity limit of $____ you no longer qualify for payment of Home and        

Community Based Services (HCBS) beginning on _____.                      

Beginning on this date, you will need to pay the service provider for the HCBS

you receive.  As long as the equity value of your resident property exceeds   

$____ you will not qualify for payment of HCBS.   If you believe that the  

denial of the payment of HCBS will deprive you of medical care, food,         

clothing, shelter or other necessities of life which would endanger your      

health or life you may ask for an undue hardship waiver.                      

                                                                              

42 U.S.C. § 1396p(f), 62 P.S. § 441.8 and 55 Pa. Code §§ 178.62a, 178.104b           

 

Issued March 12, 2012