December 1973 Eligibility Requirements Manual – Table of Contents

1040.030.30 Required Documentation

For transferred assets the individual must have exhausted all reasonable means including legal remedies to recover the assets or income or the value of the transferred assets or income that have caused a penalty period before undue hardship can be considered. The individual (or his/her representative) must submit:

  1. A statement signed by the individual (or his/her representative) which describes whether the assets are recoverable, and if not recoverable, the legal attempts that were made to recover the transferred assets, and
  2. Proof that an undue hardship would exist if the penalty period is applied (as follows):
    • If the member is currently institutionalized, the individual must submit a copy of the notification sent from the nursing facility which states both the date of involuntary discharge and alternative placement location or other proof that if the hardship waiver is not granted, the individual will be deprived of medical care such that the individual’s health or life would be endangered; or deprived of food, clothing, shelter, or other necessities of life.
    • If the member is applying for Home and Community Based (HCB), Missouri’s Children with Developmental Disabilities (MOCDD) program or Program of All-inclusive Care for the Elderly (PACE), the individual must submit an estimate of the cost of the nursing services needed to meet the individual’s medical needs (as determined by the Department of Health and Senior Services or PACE Administrator) and an estimate of costs for food, shelter, clothing and other necessities of life.

Compare the two estimates to the individual, or couple’s income and assets. For MOCDD, compare the estimate to the income and resources of the child and his/her parent(s).  All Documents are to be sent as an attachment with a Request for Interpretation of Policy (IM-14) form through supervisory channels for Income Maintenance programs. Program and Policy staff will review documents to determine whether the individual has sufficient income and/or assets to pay for the individual’s long term care.  If the individual does not have enough income and/or assets to pay for his or her long term care and other needs (i.e. food, shelter, etc.), consider the individual’s health to be endangered.

If the required documentation is not submitted with the request for an undue hardship waiver, send a written request for verification. If the applicant/participant fails to submit the required verification within 10 days after the request is mailed, deny the undue hardship waiver request and notify the individual with the Undue Hardship Decision Notice (IM-63HWD).