Appendix C: Denial of Undue Hardship Waiver Notice Text

DENIAL 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 denied:  

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. Your request for an undue hardship waiver is denied. You remain eligible for all other Medical Assistance benefits. 

Citations: 42 U.S.C. § 1396p(c) and 55 Pa. Code § 178.104a 

 

DENIAL 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 denied:  

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. Your request for an undue hardship waiver is denied. You remain eligible for all other Medical Assistance benefits. 

Citations: 42 U.S.C. § 1396p(c) and 55 Pa. Code § 178.104a 

 

DENIAL OF UNDUE HARDSHIP WAIVER REQUEST NOTICE TEXT- LTC EXCESS HOME EQUITY

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 denied:  

You previously received a notice stating you would not qualify for payment of Long Term Care (LTC) facility services because the equity value of your home exceeds the home equity limit.  You requested an undue hardship waiver. Your request for an undue hardship waiver is denied. You remain eligible for all other Medical Assistance benefits. 

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

 

DENIAL OF UNDUE HARDSHIP WAIVER REQUEST NOTICE TEXT- HCBS EXCESS HOME EQUITY

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 denied:  

You previously received a notice stating you would not qualify for payment of Home and Community Based Services (HCBS) because the equity value of your home exceeds the home equity limit.  You requested an undue hardship waiver. Your request for an undue hardship waiver is denied. You remain eligible for all other Medical Assistance benefits. 

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

 

Issued May 1, 2012