A person receiving or applying for long term care medical benefits in a nursing home (NH), supportive living facility (SLF), or through the DoA Home and Community Based Services (HCBS) waiver may apply for a hardship waiver if the person is denied such medical assistance due to:
- a penalty period arising from a non-allowable transfer of resources; or
- equity interest in the applicant's home exceeding the allowable amount. See WAG 25-03-02 (2).
A waiver may be granted if it is determined that the exclusion of NH, SLF or DoA waiver services would deprive the person of:
- medical care such that the health or life of the person would be endangered; or
- food, clothing, shelter, or other necessities of life.
A hardship waiver may be requested by any person residing in a nursing home, SLF, or receiving DoA HCBS waiver services, or by the person's authorized representative. A long term care facility may submit a claim of undue hardship on behalf of their customer if they have written authorization from the person or their authorized representative.
The person has the burden of proof that actual, not just potential, hardship exists, and must provide written evidence to clearly substantiate the circumstances supporting the hardship claim.