554 TRANSFER OF ASSETS
An individual who is institutionalized or receiving home and community based ( HCB ) waiver services and who transfers income or resources for less than fair market value may be subject to a penalty that results in a period of ineligibility for institutional or HCB services. In order for a penalty to apply, the transfer must have occurred within the look-back period.
Medicaid transfer of assets rules apply to all individuals eligible under the Special Long Term Care eligibility category and to all individuals receiving HCB waiver services, regardless of their eligibility category.
This section explains how to treat a transfer of asset for less than fair market value and includes policies in effect before and after implementation of the Deficit Reduction Act of 2005 provisions.
This section contains the policy and procedures for determining the following:
Who is subject
to the transfer of asset penalty;
Which assets
are subject to the transfer of asset rules;
The look-back
period;
Start date of
the penalty period;
When a non-allowable
transfer has occurred;
Treatment of
purchasing promissory notes, loans, or mortgages;
Treatment of
purchasing life estates;
Treatment of
annuities;
When to impose
a transfer of asset penalty;
How to calculate
the penalty period; and
Undue hardship.
554 A. DEFINITION OF TERMS RELATED TO TRANSFER POLICY
Annuity - An annuity is a contract. An individual pays an entity a lump sum of money in return for the right to receive fixed, periodic payments, either for life or for a term of years.
Compensation - Something received as payment for an asset. Payment is usually considered to be cash, but other forms of payment include in-kind income, real or personal property, support and maintenance, services, or assumption of a legal debt.
Community Spouse - The spouse of an applicant or recipient of long-term care Medicaid. A community spouse resides outside of an institution and is not receiving HCB Waiver Services.
Equity - The equity of real or personal property is the fair market value (see definition below) less any encumbrances (mortgages, liens, or judgments) on the property.
Fair Market Value - Fair market value is current market value of a resource at the time the resource is transferred. The current market value of a resource is the going price for which it can reasonably be expected to sell on the open market in the geographic area involved.
Legal Representative - A person legally authorized to execute a binding contract for the individual, such as (but not limited to) a legal guardian, parent of a minor child, power of attorney, or trustee managing the individual's assets. Legal authorization requires a legal document or court action except for parents of minor children.
Life Estate - Under a life estate, an individual who owns property transfers ownership of that property to another individual while retaining, for the rest of his or her life (or the life of another person), certain rights to that property. Generally, a life estate entitles the owner of the life estate (the grantor) to possess, use, or profit from the property as long as he or she lives. However, the grantor no longer owns the property.
Look-back Period - The period immediately prior to the date of application or review in which the caseworker will look to see if the applicant transferred an asset.
Medical Institution - An institution certified under state law to provide medical care, including nursing and convalescent care, such as hospitals, skilled nursing facilities ( SNF ), intermediate care facilities ( ICF ), intermediate care facility for the Intellectually Developmentally Disabled (ICF/IDD) ; residential psychiatric treatment centers ( RPTC ); and certain assisted living homes providing residential supported living and habilitation services, including Alaska Pioneer Homes.
Partial Month Penalty - The penalty period for transferring an asset that produces a fractional monthly amount, resulting in a partial month of ineligibility.
Penalty Period - The period of time in which a client is ineligible for institutional and HCB waiver services due to a transfer of asset for less than fair market value. See Subsection 554 L.
Transfer - To change ownership or title from one person(s) to another. A transfer also occurs when an individual takes any action that eliminates his ownership or reduces his control of an asset.
Uncompensated Value - The difference between the equity value of the asset at the time of the transfer and any payment or compensation received. The uncompensated value is the amount upon which the length of a transfer of asset penalty is based.
554 B. VERIFICATION AND DOCUMENTATION
A MED 3 Declaration / Denial of Asset Transfer form, or M723 Transfer of Asset Declaration notice, must be provided and completed for all nursing home or home and community based waiver applicants, including child waivers, when an applicant did not apply with a Med 4 Application for Adults and Children with Long Term Care Needs.
The applicant is required to provide proof of any funds held in financial accounts. If such accounts exist, the applicant must provide the last three bank statements for each account that is owned by the applicant and his or her spouse. The caseworker must also obtain this declaration when an APA/SSI/Medicaid, Family Medicaid, or Denali KidCare recipient has started the waiver process.
The applicant needs to provide proof of any funds held in financial accounts. If such accounts exist, the applicant can provide the last three bank statements for each account that is owned by the applicant and his or her spouse. Client statement is acceptable for these accounts if the statements are not readily available and the caseworker does not find the information questionable. The caseworker must also obtain this declaration when an APA /SSI /Medicaid, Family Medicaid, or Denali KidCare recipient has started the waiver process.
In addition to the initial application, look
for a transfer of asset at the time of review, when a transfer is reported,
or when there is a request for a change in institutional or HCB services.
When there has been a transfer of assets during
the look-back period, obtain the following information:
A description of the asset transferred (the home, other real property, life estate, cash, lump sum, car, stocks, bank account, certificate of deposit, etc.).
The person who transferred the asset (client, spouse, legal representative).
The name of the person(s) to whom the asset was transferred.
The client's relationship to the individual to whom the asset was transferred.
The countable value of the asset at the time of the transfer and the compensation (money or other benefit) received or expected to be received from the transferred asset.
The date the asset was transferred.
Whether the applicant was the sole owner of the asset at the time of the transfer; if not, the name of any co-owners.
If applicable, documentary evidence that the individual intended to dispose of an asset at a fair market value or information from knowledgeable sources to support the value (if any) at which the asset was disposed. See Section 554-F(3).
Document information in the CANO and explain the following transfer of assets rules to the client:
How the penalty
is calculated, and
Exceptions to
the penalty, and
How to lift or reduce the penalty period.
554 C. TRANSFER OF ASSET RULES APPLY
Transfer of asset rules apply to:
Resources - Any real or personal property, annuity, liquid resource, or funds owned by the individual and his or her spouse that is given away, sold for less than fair market value, or used to purchase a promissory note, loan, mortgage, or life estate.
Income - Any earned or unearned income (including a lump sum) of the individual and his or her spouse that is transferred to another individual in the month of receipt. See APA Manual Section 440-1 for the definition of income.
The date on which the look-back period is established is based on the date an individual applies for long term care services, or the date the individual is institutionalized, whichever is later. For example, an individual entered a nursing facility in June and submitted an application during the month of July; the July application date sets the look-back period.
Note:
The look-back period should be measured from the date the transfer of property
actually occurred, not necessarily when the transfer was officially recorded.
An unrecorded conveyance is valid.
The look-back period is 60-months for non-trust transfers of assets for less than fair market value made on or after February 8, 2006.
Take the following steps when determining the look back period:
1. Evaluate all transfers beginning on or after the look-back date.
2. Do not consider transfers made prior to this date.
3. A transfer penalty must be determined for all non-allowable transfers within the look-back period.
4. Document the findings in the CANO.
Although eligibility is determined month-by-month, the look-back period is day specific.
Example 1:
Mr. Sherwood is institutionalized on May 20, 2015. He applies for
Medicaid on May 26, 2015. He has a 60-month look-back period from
May 26, 2010 through May 26, 2015.
For asset transfers made on or after February 8, 2006, the penalty begins the first day of the month the individual is eligible for Medicaid and would be receiving institutional level of care services, except for the imposition of a transfer of asset penalty.
554 F. ASSET TRANSFERS NOT RESULTING IN PENALTY
DO NOT apply a transfer of asset penalty for:
Real or personal property or liquid assets that are transferred or exchanged in return for money or other tangible object, service, or benefit that is equal to or greater than the equity of the transferred asset is a compensated transfer. Transfers for services to be provided in the future are not allowable because they have not been compensated.
2. Excluded Asset at the Time of Transfer
An asset that is exempt at APA Manual Section 433-1(B) is an allowable transfer not subject to a transfer of asset penalty.
3. Intent to Dispose of Assets for Fair Market Value or for Other Valuable Consideration
The individual intended to dispose of the assets either at fair market value or for other valuable consideration. The individual must provide written evidence of attempts to dispose of the asset for fair market value, as well as proof to support the value at which the asset was disposed.
Example 2:
Ms. White owns rental property with a tax value of $50,000. There are no
encumbrances on the property. She lists the property with a realtor
for the current market value of $50,000. After several months, Ms. White
received a firm offer for $40,000. She accepted the offer. This example
documents that Ms. White intended to sell her property at the current
market value, but she only received a portion of that amount. Do not apply
penalty to the difference between the current market value and the compensation
received.
4. Transfer for Other Purposes
Assets transferred exclusively for a purpose other than to qualify for Medicaid or remain eligible for Medicaid at a future date. The individual must provide convincing evidence to the specific purpose for which the asset was transferred.
The transferred asset for less than fair market
value is returned to the client.
Transfer of the home is an allowable transfer only when it is transferred to one of the following:
Legal spouse;
Child under age 21;
Blind/disabled (determined by SSA) child of any age;
Sibling who is a co-owner of the home and has been residing in the home for a period of at least one year immediately before the applicant or recipient was institutionalized; or
Adult child who resided in the home for at least two years immediately before the applicant or recipient entered an institution or began receiving home and community based waiver services, and who for the entire two-year period provided care to the disabled parent such that it prevented the need for the parent to enter the institution or to begin receiving HCB waiver services.
Note:
Verification must be provided that the adult child resided in the home
during the two years, and that the adult child provided necessary care.
Income transferred to a Medicaid Qualifying Income Trust, or income and resources transferred to a Special Needs or Pooled Trust established for the sole benefit of an individual under age 65 who is disabled as defined under SSI rules.
8. Transfers to Prevent Spousal Impoverishment
Transfers made under Section 553-F are not subject to penalty.
9. Transfers of Federal Income Tax Returns
Federal income tax returns are not subject to Medicaid transfer of asset penalty provisions for 12 months from the date payments are received. However, payments given away after the end of the exempt period are subject to transfer of asset penalty provisions.
554 G. TRANSFERS TO A SPOUSE, CHILD, OR A DISABLED PERSON
Transferring an asset to the individuals spouse, child, or to a disabled person is not subject to transfer of asset penalty if the asset was transferred:
To the individuals spouse or to another for the sole benefit of the individuals spouse;
From the individuals spouse to another for the sole benefit of the individuals spouse;
To the individuals child, or to a trust established solely for the benefit of the individuals child, provided the child meets the SSI criteria for blindness or disability; or
To a special needs trust established for the sole benefit of a person under age 65 who meets the SSI criteria for disability.
To verify that a transfer of assets is for the sole benefit of an individuals spouse, child, or a disabled person, there must be a written document that legally binds the parties to a specified course of action and identifies who can benefit from the assets.
If there are restrictions placed on transfers that limit the availability of assets to the individual's spouse, child, or a disabled person, email dpapolicy@alaska.gov. Also, please contact the Medicaid Specialist if there are any other indications that the transfer is intended to benefit someone besides the individual's spouse, child, or a disabled person.
554 H. NON-ALLOWABLE TRANSFERS
A non-allowable transfer occurs when any action is taken that causes income or resources of the individual or the individual's spouse to be transferred to another, including:
Irrevocably waiving
pension income;
Waiving the right
to receive an inheritance;
Not accepting or accessing
injury settlements;
Agreeing to a tort settlement that allows the defendant to divert the tort settlement proceeds into a trust, annuity, or similar device to which the plaintiff (who is an applicant or recipient), or the plaintiff's parent or guardian, does not have any access or control. This prohibition does not apply if the proceeds are placed into a recognized Medicaid trust established by the applicant or recipient.
Refusing to take legal
action to obtain a court-ordered payment that is not being paid, including
child support or alimony; or
Reducing the individual's ownership or control of an asset.
Example 3:
Ms. Hamm added her niece's name to her $30,000 savings account in
January so either party could access the account independently. This
is an "OR" account. (For Medicaid purposes, the entire $30,000
would still be considered available to her and is not subject to a transfer
of asset penalty.) However, in April, her niece withdraws the $30,000
from the joint account and puts it into her own account, which eliminates
Ms. Hamm's ownership, thus Ms. Hamm is subject to a transfer of asset
penalty beginning in May.
Example 4:
The same situation as above, but in January the account is changed to an
"AND" account. An "and" account requires the
signature of both parties to access, thus reducing the clients control
of the asset. In this situation, Ms. Hamm is subject to a transfer of
asset penalty beginning in February.
Note:
It is not a transfer of asset for less than fair market value if the reason
for failure to receive an asset is because the individual cannot afford
to take the necessary action to obtain the asset or the cost of obtaining
the asset is equal to or greater than the assets worth.
554 I. PROMISSORY NOTES, LOANS, OR MORTGAGES
A promissory note, loan, or mortgage is treated as a transfer of asset unless all of the following criteria are met:
The repayment term is actuarially sound (i.e., the beneficiary is expected to live long enough to receive all of the payments); and
Payments are made in equal amounts during the term of the loan with no deferral of payments and no balloon payments; and
The promissory note, loan or mortgage prohibits the cancellation of the balance upon the death of the lender.
Note:
Use the period life table published by the Social Security Administration
online at http://www.ssa.gov/OACT/STATS/table4c6.html.
If an individual has a life estate, the caseworker must investigate whether a transfer of asset for less than fair market value occurred. If the value of the asset transferred by the individual is greater than the value of the life estate, a transfer of asset for less than fair market value has occurred.
The value of the life estate is the amount that it would sell for as of the first moment of the month. This value is determined by multiplying the fair market value of the property by a decimal value based on the life estate holder's life expectancy.
Note:
Use the life estate tables published by the Social Security Administration
online at https://s044a90.ssa.gov/apps10/poms.nsf/lnx/0501140120.
If the value of the property exceeds the fair market value of the life estate, the difference between the property value and the life estate value is treated as an asset transfer.
Example
5:
Ms. Pedersen, age 65, owns a house worth $100,000. She deeds
the house to her son but retains a life estate in the property. Under
the terms of the life estate, Ms. Pedersen is entitled to live in the
house for the rest of her life. To determine the value of Ms. Pedersen's
life estate, the current market value of the property ($100,000) is multiplied
by a life estate factor corresponding to Ms. Pedersen's age in the table
(.67970), resulting in a life estate worth $67,970. The penalty
is assessed for the difference between the value of the asset transferred
($100,000) and the value of the life estate ($67,790), resulting in $32,210
uncompensated transfer.
The purchase of an annuity by an applicant or a spouse is an allowable transfer when all of the following conditions are met:
It
is purchased with proceeds from an employee retirement account or
trust, employee pension, or Roth Individual Retirement Account;
OR
It
is irrevocable and nonassignable; and
It
is actuarially sound (i.e., the beneficiary is expected to live long
enough based on the beneficiary's age at the time the annuity is purchased
to receive all of the payments); and
It
is paid out in equal monthly payments with no deferral and no balloon
payments.
In addition,
an allowable annuity must name the State as remainder beneficiary
in
the first position for the total amount of medical assistance paid
on behalf of the individual, including both long-term care services
and waiver services, or
in the second position if there is a community spouse, or a minor or disabled child.
Note:
Caseworkers must email TPL at DMATPL@Alaska.gov whenever
an annuity is approved for a case and the State of Alaska is the beneficiary
of that annuity.
To determine if a transfer for less than fair market value has occurred, take the following steps:
Determine the number of years the beneficiary is expected to live based on the beneficiary's gender and age at the time the annuity is purchased.
Note:
Use the actuarial tables published by the Social Security Administration
online at www.ssa.gov/OACT/STATS/table4c6.html.
Multiply the annual amount scheduled to be paid out by the annuity by the number of years the beneficiary is expected to live. Round to the nearest dollar. This is the amount that the annuity is expected to pay out.
Compare this amount to the purchase price of the annuity.
When the amount that is expected to be paid out during the beneficiary's lifetime is equal to or greater than the purchase price of the annuity, the individual will receive fair market value for his investment. This is an allowable transfer. Do not apply a penalty.
When the purchase price of the annuity is greater than the amount that is expected to be paid out in the beneficiary's lifetime, the difference between the two amounts is an uncompensated transfer and subject to penalty.
Example
6:
Mr. Ashe, age 65, purchases a $10,000 annuity for himself to be paid out
at an annual rate of $1,000 per year over the next ten years. His life
expectancy at age 65 is 15.52 years. Since he is expected to live
long enough to receive the full value of the annuity, the annuity is an
allowable transfer.
Example
7:
Mr. Rogers, age 85, purchases a $10,000 annuity to be paid out at an annual
rate of $1,000 per year over the next ten years. His life expectancy
at age 85 is 5.20 years. Since he is not expected to live long enough
to receive the full value of the annuity, an uncompensated transfer has
occurred and a penalty must be applied. The value of the uncompensated
transfer is $4,800 (10 years minus 5.20 years = 4.80 years x $1,000 =
$4,800). Mr. Rogers is subject to a four-year, eight-month penalty.
Note:
The allowable transfer of asset policy described above does not apply to
revocable and/or assignable annuities. Instead, such annuities are
considered as
countable resources.
If a revocable annuity is cancelled, the funds used to purchase the annuity
may be refunded to the purchaser. If the owner or payee may be changed,
it means the annuity is "assignable," which in turn means the
annuity can be sold on the secondary market. In either case, an
annuity that meets one or both of these criteria is a countable resource.
If the annuity is revocable, the resource value is the amount that
the purchaser would receive if the annuity is cancelled. If the
annuity is assignable, the resource value is the amount the annuity can
be sold for on the secondary market.
554 L. TRANSFER PENALTY AND PARTIAL MONTHS
Partial months of ineligibility will be imposed when the calculation of the penalty period for transferring an asset produces a remainder amount. This calculation is based on the monthly nursing home rate in the community in which the individual is institutionalized. If unable to determine which community the individual would receive nursing facility services, use the current swing-bed rate as determined by the Division of Health Care Services, Office of Rate Review, and provided by DPA Policy to eligibility workers upon request.
To determine the uncompensated value of a transfer:
Determine and list the date(s) of each non-allowable transfer occurring during the look-back period.
Establish
the fair market value of the transferred asset at the time of transfer.
Subtract
any encumbrances from the fair market value to establish the equity
of the asset.
Establish
the amount or value received for the transferred asset.
Subtract from the equity the amount received. This is the uncompensated value.
For transfers
made on or after February 8, 2006
Add
the uncompensated value of each transfer in the look-back period.
Divide
the total uncompensated value for all transfers by the average monthly
cost to a private patient of nursing home care in the individual's
community. If unable to determine in which community the individual
would receive nursing facility services, use the current swing-bed
rate.
When
the calculation of the penalty period produces a remainder, the penalty
will include a partial month disqualification.
The
result is the number of full and/or partial months for the penalty
period.
The
period of ineligibility begins once an individual is institutionalized,
and eligible for Medicaid. The period runs continuously through
the end of the penalty period, even if the individual subsequently
stops receiving institutional level of care.
Example
8:
Mr. Reed entered a nursing facility in November 2007 and applied for Medicaid
on December 5, 2007.
He made one transfer during the look-back period. He transferred
real property with an equity value of $150,000 on February 20, 2006, receiving
no compensation.
The average monthly cost to a private patient in a nursing home in his
community is $9,630. The uncompensated transfer amount of $150,000
is divided by the average monthly rate of $9,630 and equals 15.58 months.
Because Medicaid eligibility begins on the first day of the month,
the full 15-month penalty period runs from December 2007 through February
2009, with a partial month penalty calculated for March 2009:
$150,000 uncompensated transfer amount
÷ 9,630
monthly rate
= 15.58 number of months for penalty
period
31 number of days in March 2009
x .58
partial month penalty period
= 17.98 number of days for partial month
penalty
The partial month penalty of 17 days (rounded down) is added to the 15-month
penalty period. This means that Medicaid will begin payment for
long-term care coverage on March 18, 2009.
4. Multiple Penalty Periods Overlap.
When assets
have been transferred so that multiple penalty periods overlap, combine
the uncompensated value of all assets transferred and compute a single
penalty period.
Example
9: (For transfers made on or after February 8, 2006)
Mr. Crowe entered a nursing facility on July 2, 2007. The average
monthly cost to a private patient in a nursing home in his community is
$9,630. He applied for Medicaid on August 12, 2007. The look-back
period begins August 12, 2007.
He made the following transfers during the look-back period: $20,000 on
January 20, 2007, another transfer of $15,000 on September 6, 2006, and
another transfer of $10,000 on February 10, 2006.
The total uncompensated transfer amount of $45,000 is divided by the average
monthly rate of $9,630 and equals 4.67 months. This results in giving
a partial month penalty. Because Medicaid eligibility begins on
the first day of the month, the full four-month penalty period runs from
August 2007 through November 2007 with a partial month penalty calculated
for December 2007:
$45,000 total multiple uncompensated transfer amount
÷ 9,630 monthly
rate
= 4.67 number of months for penalty
period
31 number of days in December 2007
x .67
partial month penalty period
= 20.77 number of days for partial months penalty
The partial month penalty of 20 days (rounded down) is added to the four-month
penalty period. This means that Medicaid will begin payment for
long-term care coverage for Mr. Crowe on December 21, 2007.
When both spouses are institutionalized or receiving HCB waiver services, divide the penalty period between the spouses. The total penalty imposed on both spouses cannot exceed the number of months of the penalty period.
When one spouse is no longer subject to a penalty (i.e., the spouse no longer receives institutional services or the spouse dies),
the remaining penalty period applicable to both spouses must be served by the remaining spouse.
If a community spouse is later institutionalized or receives waiver services and a penalty period is still in effect for the first institutionalized spouse:
Divide the remaining penalty period equally between the spouses.
Do not establish a new look-back period. The client's initial look-back period for the first institutionalized spouse is the same for the former community spouse.
Determine if any additional transfers were made by the former community spouse during the look-back period. Apply the same rules when considering an asset subject to transfer of asset penalty.
A transfer that occurred during the portion of the community spouses look-back period that does not overlap with the look-back period of the first institutionalized care spouse is subject to a transfer penalty. Only the former community spouse is subject to that penalty.
When both spouses are approved at the same time, the extra month is applied to the one with the earlier birth date.
Example
10: (For transfer made on or after February 8, 2006)
Mr. Gibson enters a nursing a facility and applies for Medicaid. Mrs.
Gibson transfers an asset that results in a 12.64 month penalty against
Mr. Gibson. Four months into the penalty period, Mrs. Gibson
enters a nursing facility and applies for Medicaid. The penalty
period against Mr. Gibson still has 8.64 months to run.
Because Mrs. Gibson is now in a nursing facility and a portion of the original
penalty period remains, the remaining 8.64 months of penalty is divided
between Mr. and Mrs. Gibson. Therefore, Mr. and Mrs. Gibson each
have a four month penalty. Because there is a partial month,
the extra days are assigned Mr. Gibson. The partial month is given to
the spouse who entered the institution or receives waiver approval first.
When both spouses are approved at the same time, the partial month is applied to the one with the earlier birth date.
Linda Walsh in the Division of Health Care Services (DHCS) at Linda.Walsh@alaska.gov, and copy Douglas Myers at Douglas.Myers@alaska.gov and Kristin Delfino at Kristin.Delfino@alaska.gov; and
The Division of Senior and Disability Services ( DSDS) at longterm.careunit@alaska.gov with the date of Medicaid closure. This is necessary so that DSDS can discontinue issuing Prior Authorizations for HCB Waiver and Nursing Home services.
The following information must be given:
Name and identification number of the client;
Date of penalty start;
Date of penalty end; and
Long term care or waiver services are not to be authorized or paid for until after the penalty end date.
The Division of Health Care Services will enter the penalty end date into the Medicaid Management Information System (MMIS) to prevent long term care or waiver service claims from being paid until the penalty ends.
An undue hardship exists when a transfer of asset penalty would deprive the applicant, recipient, or community spouse of:
medical care such that the individual’s
life or health would be endangered; or
food, clothing, shelter, or other basic necessities of life.
If a transfer of assets penalty is imposed on an individual, a timely notice of the penalty must be sent. The notice must state that
The penalty will be imposed 10-days after
the date of the notice;
An undue hardship exception exists;
The request for an undue hardship exception
must be submitted within 30 days of the date the notice was mailed;
the individual, or the facility in which the institutionalized individual
is residing can request an undue hardship on behalf of the individual
with the consent of the individual or the authorized representative
of the individual. The facility must have the consent of the
individual or the individual’s personal representative. In addition,
the facility may present information on behalf of the individual to
the Department. The facility may represent the individual throughout
the appeals process with the specific written consent of the individual
or the individual’s authorized representative;
An undue hardship determination will be
made within 30 days of receipt of the request; and
A denial of a hardship determination can be appealed.
The individual or facility acting on behalf of the individual must submit a written statement to the caseworker indicating how the individual or his or her community spouse would be subject to undue hardship and describes:
Why the assets transferred for less than
fair market value cannot be returned; and
What efforts the applicant or recipient has made to have the assets returned.
The request should be sent to the Medicaid Specialist at dpapolicy@alaska.gov. The Medicaid Specialist will:
evaluate requests for undue hardship exceptions.
notify the Division of Health Care Service’s
( DHCS ) Third Party Liability ( TPL ) Claims Unit of the request.
This unit will pend all institutional and HCB
waiver service claims made within the ten-day notice period, and deny
claims after the ten-day notice period. Claims will be pended
until ten days after the agency notifies the client of the determination.
email the finding of undue hardship to the eligibility caseworker.
If a finding of undue hardship is made, no penalty applies.
|
||
|
|