Appendix F: Approval of Undue Hardship Waiver Request Notice

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

 

When an undue hardship is approved for an expired penalty period, 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.  Effective

 ___________ , you qualify

for payment of services in a 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 , 181.453 and 255.4 

 

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

 

When an undue hardship is approved for an expired penalty period, 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.  Effective

 __________, 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.  

 

                                    

                                                                             

42 U.S.C. 1396p(c), 1396p(f); 62 P.S. 441.8,  55 Pa. Code 178.104b,  and 255.4 

 

Updated March 14, 2023,replacing May 2, 2016