804 Undue Hardship Claims for Trusts

Policy

The trust provisions may be waived when denying eligibility for long term care services creates an undue hardship.  Undue hardship exists when applying the trust provisions would deprive the customer of:

·        Medical care such that his or her health or life would be endangered; or

·        Food, clothing, shelter, or other necessities of life due to the customer’s income at or below 100% of the federal poverty level (FPL). See MA615.2 Income Standards for FPL limits.

Undue hardship does not exist when application of the trust provisions only causes inconvenience or restricts the customer’s lifestyle but would not put him or her at risk of serious deprivation.

To qualify for an undue hardship, ALL of the following conditions must be met:

·        The customer does not have the income or resources to pay for the medical care that he or she needs;

·        The customer does not have any other means of obtaining the medical care that he or she needs, including other insurance, benefits or third-party liability; and

·        The customer qualifies for ALTCS except for trust policy.

Undue hardship decisions are made on a case-by-case basis.  

Definitions

Proof

Proof includes:

·        A written statement from the customer that he or she is requesting an undue hardship determination, and the reason the customer believes an undue hardship exists;

·        Proof of the customer’s medical needs and expenses;

·        Proof of income and resources for all months for which the customer is requesting an undue hardship;

·        Proof of any medical insurance the customer has; and

·        Any other information to support the customer’s claim of undue hardship.

Legal Authority