PM 01-08-01

Hardship Waiver Examples - Penalty Period

Example 1:

Ms. A files a request for a hardship waiver after of the imposition of an 8-month penalty period beginning September Revised text2012, due to her transfer of $45,500 to her nephew. She submits the following:

  • a notice from the LTC facility confirming that she will be discharged from the facility if she cannot pay;
  • Revised texta doctor's statement confirming that Ms. A needs skilled nursing care which cannot be provided in a home setting due to the specifics of her illness; and
  • bank statements showing that she has only $2,500 remaining.

She submits no verification of any correspondence with her nephew or of any attempt to recover the money she gave to him. HFS Revised textOIG determines that a hardship exists, but Ms. A has failed to meet the requirement that she make all reasonable and legal efforts to recover the transferred funds. She has also failed to refute the presumption that the transfer to her nephew was made primarily for the purpose of making herself eligible for medical assistance. The hardship waiver is denied.

Example 2:

Ms. A files a request for a hardship waiver, as above, and submits the notice from the facility and the doctor's statement. She also submits copies of letters she wrote to her nephew, requesting the return of the transferred resources or income. The letters were returned to her by the post office, marked "address unknown." Ms. A also submits statements from other family members confirming that the nephew has left the area and his whereabouts are unknown. Finally, she submits evidence that her nephew lost his job in Revised textDecember 2011, and states that the payments to him were to help him out until he found new employment.

The Revised textOIG reviewer determines that:

  • a hardship exists New textand Ms. A will be deprived of medical care to the extent that her health or her life will be endangered;
  • Ms. A has met the requirement of making all legal and reasonable efforts to recover the transferred resources or income; and
  • the transfers were not made to qualify for medical assistance.

The hardship waiver is granted.