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 to Applicant sent to the person 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 to Applicant sent to the person 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 May 1, 2012