MEMORANDUM

DISCUSSION:

The purpose of this memo is to introduce policy, forms, and processes to provide individuals, who are ineligible for MO HealthNet for the Aged, Blind, and Disabled (MHABD) vendor, Home and Community Based (HCB), Missouri’s Children with Developmental Disabilities (MOCDD) program or Program of All-inclusive Care for the Elderly (PACE) because of a transfer of assets penalty, with the opportunity to request a waiver of the transfer penalty because of undue hardship.

The Deficit Reduction Act of 2005 Section 6011 (d); section 1917 of the Social Security act in 42 U.S.C 1396p (2)(D) required each state to provide a hardship waiver process. Under the DRA, undue hardship exists when application of a transfer of asset penalty would deprive an individual of:

• Medical care such that the individual’s health or life would be endangered; or
• Food, clothing, shelter, or other necessities of life.

The eligibility specialist (ES) must manually send notification to individuals who are assessed a transfer of assets penalty. The Undue Hardship Waiver Letter (IM-63 HWN) is designed to provide this notification of the undue hardship waiver process and criteria for granting a hardship waiver.

NOTE: Send the IM-63 HWN the same date actions are authorized to impose the transfer penalty.

The MO HealthNet Undue Hardship Waiver Request (IM-63 HWR) is designed for individuals to request a waiver of the transfer of asset penalty because of an undue hardship. ES will provide IM-63 HWR upon request of the customer, the authorized representative, or the vendor facility. This form may also be used to authorize the nursing facility to request the waiver on the individual’s behalf and to represent the individual in hearing proceedings.

NOTE:  The IM-63 HWR must be date stamped by the Family Support Division (FSD) office when received.

When a request for undue hardship waiver is received, the ES will request:

• Documentation of the individual’s life threatening medical needs, and/or
• Documentation of the individual’s income, assets, and expenses (i.e. Food, shelter, etc.), reflecting the individual’s inability to meet basic needs; and
• Statement signed by the individual (or his/her representative) which describes whether the assets are recoverable; and
• Documentation of legal attempts to recover the transferred assets.

Allow the individual 10 days to provide the requested verification.

The ES will submit the IM-63 HWR and documentation on a Request for Interpretation of Policy (IM-14) form through supervisory channels to Income Maintenance Program and Policy at cole.mhnpolicy@dss.mo.gov. Program and Policy will make the determination of the undue hardship and the begin date of the waiver, if approved, and advise the ES of the decision.

If the waiver request is received by the FSD within 10 days of the notice of transfer penalty, the waiver, if approved, will be effective with the initial date of the penalty. This will result in no loss in benefits to individual due to the transfer.

EXAMPLE:  Amy applied for MHABD vendor on January 20. Amy receives a FAMIS notice and the IM-63 HWN dated February 10 that her application for vendor is being denied and that she will have a 100-day penalty period beginning January 20.

Amy submits an undue hardship request to FSD, which is received on February 15 (within 10 days of the notice). The undue hardship request is approved by MHN Program and Policy, and Amy’s penalty period is waived. Amy is subsequently certified for vendor beginning January 20.

If the waiver request is received more than 10 days after the notice of transfer penalty, the waiver, if approved, will begin the date the request was received.

Example: Alice receives a notice dated February 10 that her January 20 application for HCB is being denied and that she will have a 350-day penalty period beginning January 20. In June, Alice’s health deteriorates and her monthly income decreases by 60%. Alice submits an undue hardship request to FSD, which is received on June 25. The undue hardship request is approved by MHN Program and Policy.  Alice’s remaining penalty period is waived and she’s subsequently certified for HCB beginning June 25.

The ES will send the Undue Hardship Waiver Decision (IM-63 HWD) form to the individual. If there is an authorized representative, they must also receive a copy of the IM-63 HWD. The individual is entitled to hearing rights if they disagree with the decision on the undue hardship waiver request. If a hearing is requested by the individual or their authorized representative complete the Application for State Hearing (IM-87) form and forward to the appropriate Administrative Hearings Unit through normal channels.

NECESSARY ACTION:

• Review this memorandum and Income Maintenance Manual policy with appropriate staff.
• Immediately begin sending manual notification (IM-63 HWN) of the hardship waiver process to all vendor/HCB/PACE/MOCDD applicants/participants who are assessed a transfer of assets penalty.
• Begin using the MO HealthNet Undue Hardship Waiver Request (IM-63 HWR) when a customer requests a waiver of the transfer penalty because of undue hardship.
• Forward completed IM-63 HWR forms and supporting documentation with an IM-14 through normal supervisory channels to MHN Program and Policy.
• Send the Undue Hardship Waiver Decision (IM-63 HWD) form upon receipt of the decision.
• New forms are attached and also available in the Forms Manual Vol II.

ATTACHMENTS:

• MO HealthNet Undue Hardship Waiver Letter (IM-63 HWN)
• MO HealthNet Undue Hardship Waiver Request (IM-63 HWR)
• MO HealthNet Undue Hardship Waiver Decision (IM-63 HWD)

AC/ks/vb