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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
17.17.2 Hardship Waiver Request Process
17.17.4 Effective Date of Approved Hardship Waivers
17.17.4.1 Timely Request Received Within 20 days After Notification Is Mailed
17.17.4.2 Untimely Request Received Later Than 20 days After Notification Is Mailed
17.17.5 Required Documentation
17.17.6 Determination Process Timeframe
17.17.7 Bed Hold Payments and Notification
A divestment penalty period must be waived when the imposition of the penalty period deprives the individual of:
Medical care such that the individual’s health or life would be endangered; or
Food, clothing, shelter, or other necessities of life.
At the same time that the worker issues the manual Negative Notice of Decision (F-16001) to the applicant or member informing the person of the divestment penalty period, the following forms must also be completed and mailed with the Negative Notice of Decision:
Divestment Penalty and Undue Hardship Notice (F-10187).
Undue Hardship Waiver Request form (F-10193) to the Hardship Notice, including the Case Name and Number.
The completed Undue Hardship Waiver Request form (F-10193) must be submitted to the IM agency. A written and signed request that fulfills the minimum request requirements is also acceptable.
The Long Term Care (LTC) facility in which the individual is residing may also file an undue hardship request on behalf of the institutionalized individual. However, the LTC facility must have the client or their authorized representative’s written permission, using the Undue Hardship Waiver Request form (F-10193) to file the undue hardship request.
The LTC facility can also represent the institutionalized individual in any subsequent fair hearing activity involving an undue hardship request/denial, as long as the facility has the member 's (or his or her representative’s) written permission to do so. This can also include the actual request for a fair hearing.
If the valid request for an undue hardship waiver is received by the local agency within 20 days after the local agency mails out the Divestment Penalty and Undue Hardship Notice (F-10187), and the request is approved, the effective date of the waiver will be the initial date of the penalty period.
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Example 1: Amy receives a notice dated February 10 that her January 20 application for community waivers is being denied and that she will have a 100-day divestment penalty period beginning January 20. Amy submits an undue hardship request to the IM agency that is received on February 15. The undue hardship request is ultimately approved by the IM agency and Amy’s penalty period is waived. Amy is subsequently certified for Community Waiver Medicaid beginning January 20. |
A request may be submitted later than 20 days after the local agency mails out the Divestment Penalty and Undue Hardship Notice (F-10187), (for example, when there is a change in circumstances), but if approved, the hardship waiver effective date will not be earlier than the date of the request.
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Example 2: Alice receives a notice dated February 10 that her January 20 application for Home and Community-Based Waivers (HCBW) is being denied and that she will have a 350-day divestment penalty period beginning January 20. In June, Alice’s health deteriorates and her monthly income decreases by 60 percent. Alice submits an undue hardship request to the IM agency that is received on June 25. The undue hardship request is ultimately approved by the IM agency, and Alice’s remaining penalty period is waived. Alice is subsequently certified for HCBW Medicaid beginning June 25. |
The applicant (or his or her representative) must submit the following verification of hardship:
A statement signed by the individual (or his or her representative) which describes whether the assets are recoverable, and if so, the attempts that were made to recover the divested assets, and
Proof that an undue hardship would exist if the penalty period is applied (as follows).
If the member is currently institutionalized, he or she must submit a copy of the notification sent from the LTC 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 HCBW, including FamilyCare, PACE , or Partnership , he or she must submit an estimate of the cost of the LTC services needed to meet his or her medical and remedial needs (as determined by the waivers case manager) 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. If the IM agency determines that the individual does not have enough income and/or assets to pay for his or her LTC 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/member 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 (F-10188). Extend the deadline to submit the required documentation for up to ten days when the individual communicates a need for additional time or assistance in obtaining it.
A decision about whether to grant an undue hardship waiver shall be made by the local IM agency within 30 days after receipt of the request. Send the member/applicant the appropriate manual Positive or Negative Notice of Decision based on the IM agency’s decision.
If an undue hardship is approved, a new hardship request does not have to be done at review. Once an undue hardship request is approved, either the entire penalty period is waived, or the remaining penalty period is waived, depending upon whether or not the client makes a timely or untimely undue hardship waiver request. If the undue hardship request is denied, the client has the right to make another subsequent request, if and when their circumstances change.
When a hardship waiver request is received by an IM agency from an institutionalized individual, the agency will send the institution the Undue Hardship Bed Hold Notice (F-10189) to inform them that the request was received. The Notice will inform the institution that a "bed hold” payment will be made on the client’s behalf for the period of time while the IM agency is making a decision about the hardship waiver request. The period covered begins on the date a written hardship waiver request is received at the IM agency until the date the agency issues its decision on the waiver request, up to a maximum of 30 days.
Use the Undue Hardship Waiver Decision (F-10188) to notify the institution of the agency’s decision about the undue hardship waiver and the availability of the bed hold payment (when applicable).
If the request for an undue hardship waiver is approved, the penalty period will be waived and the need for a bed hold payment is therefore unnecessary. If the undue hardship waiver request is denied, indicate on the Undue Hardship Waiver Decision form the dates for which the state will make the bed hold payments. Attach a copy of the Undue Hardship Waiver Decision form to the manual Negative Notice of Decision that you send the member/applicant.
The Negative Notice must include the agency’s reason for the denial, "You have not proven that the divestment penalty will create an undue hardship for you." The Notice must also inform the member/applicant that Medicaid/ForwardHealth will pay for LTC services received during the bed hold period. Manually certify the bed hold period by completing a manual Medicaid certification form (F-10110 - formerly DES 3070) (see the Process Help Handbook Section 81.3 Electronic F-10110 [formerly the 3070 and HCF-10110]) and sending it to the fiscal agent for processing.
Only one bed hold payment will be made for each divestment penalty period. Bed hold payments can only be made on behalf of individuals residing in medical institutions (i.e. nursing homes, etc.) who are requesting an undue hardship determination. They will not be made for individuals not residing in a medical institution.
If the request for an undue hardship waiver is denied, the individual has the right to appeal the decision through a written request to the DHA (see the Income Maintenance Manual Chapter 3 Fair Hearings). The individual has 45 days from the date of the notice issuance to file the appeal. These same hearing rights are also applicable to the facility in which the individual resides, as long as the facility has the institutionalized individual’s written permission to represent him or her in the appeal process.
If a Power of Attorney (POA) or other authorized representative transferred the asset, the IM agency must consider making a referral to the local Adult-at-Risk agency for investigation of possible financial exploitation of an elderly , blind, or disabled individual.
This page last updated in Release Number: 15-01
Release Date: 06/10/2015
Effective Date: 06/10/2015
The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.
Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.
Publication Number: P-10030