Appendix F: Approval of Undue Hardship Waiver Request Notice

APPROVAL OF UNDUE HARDSHIP WAIVER REQUEST NOTICE TEXT-LTC ASSET TRANSFERS OR EXCESS HOME EQUITY

 

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 granted:  

 

You requested an undue hardship waiver which we are now granting.  You qualify

for payment of services in an Long Term Care (LTC) facility, but you must make

a monthly payment towards your cost of care. Details of this monthly payment

towards your cost of care are found in the LTC section.                      

 

42 U.S.C. 1396p(c), 1396p(f)

 55 Pa. Code 178.104b, 181.452 and 181.453 

 

APPROVAL OF UNDUE HARDSHIP WAIVER REQUEST NOTICE TEXT-HCBS ASSET TRANSFERS OR EXCESS HOME EQUITY

 

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 granted:  

 

You requested an undue hardship waiver which we are now granting.  You qualify

for payment of Home and Community Based Services (HCBS)  in the               

______ Waiver. The Service Provider/Coordinator will notify you when your HCBS will begin.  

 

NOTE:  If an individual is receiving services in any of the  OLTL waivers,  the following text must be included:

 

 

In the event that you desire more or different services than are available under the Office of Long Term Living (OLTL) Waiver to which  you have been assigned, including any OLTL Waiver for which there is a waiting list, you or your representative can request to be transferred to another Waiver by contracting your Service Coordinator and request such a transfer.      

 

For additional information regarding OLTL Waivers, please contact the OLTL Participant Hotline at 1-800-757-5042.                                     

                                                                             

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

 

Updated May 2, 2016  Issued March 12, 2012