PM 01-08-00

When the FCRC denies coverage for long term care services (nursing home, SLF, or DoA waiver) due to a penalty period imposed because of a non-allowable transfer or because the person has equity over Revised text$536,000 in his or her home, take the following steps:

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  1. (Customer or Authorized Representative) New textContacts the HFS Benefits Hotline at 800-226-0768 after a decision is made to request a hardship waiver.
  2. New text(Benefits Hotline) Sends Application for Hardship Waiver (HFS 2378WA) to the customer or his/her authorized representative.
  3. New text(Customer or Authorized Representative) Completes HFS 2378WA and returns it to the mailing address or the fax provided at the bottom of the form.
  4. Revised text(OIG) Contacts the LOA via email (copies the ROA) to request additional information from the FCRC, if necessary. The inquiry will identify the case by name, number and caseload and specify the information needed. A scanned copy of the waiver request will also be attached. 
  5. New text(FCRC) Sends the requested information to OIG via fax or by scanning and emailing the documents and information needed.
  6. (Revised textOIG) Reviews the hardship waiver request and accompanying evidence (see PM 01-08-01 and PM 01-08-02). Decides whether to approve the waiver.
  7. (Revised textOIG) Sends the customer HFS 458WA, Notice of Decision on Application for Hardship Waiver, which includes a notice that the decision may be appealed. Sends a copy of HFS 458WA to the FCRC.

New textIf the penalty period resulted from a transfer for less than FMV made before 11/01/11, the OIG reviewer sends the customer or his/her authorized representative a Statement of Hardship - Waiver of Penalty Period (HFS 2379WA). The customer must complete and return the form to the mailing address or the fax at the bottom of the form before the penalty can be waived. The penalty period can be revised only if authorized by HFS OIG.