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Chapter: 1600 Assets Program: MSSI, SFP 9

1640.0307.05 Undue Hardship for Excess Home Equity Interest (MSSI) The home equity provision may be waived when denial of long-term care services would result in demonstrated hardship to the institutionalized individual.

To successfully establish undue hardship, the individual or their designated representative or legal representative must claim and demonstrate the Medicaid applicant/recipient would be deprived of medical care to such an extent that their life or health would be endangered or that the individual would be deprived of food, clothing, shelter or other necessities of life if determined ineligible for Medicaid long-term care services.

Endangerment exists when the absence of medical care will cause acute symptoms of such severity that will result in serious jeopardy to the health of the individual or serious impairment of bodily functions or serious dysfunction of a bodily organ or part. Endangerment must be documented by a medical doctor with knowledge of the applicant/recipient’s medical condition at the time an application or reapplication for Medicaid long-term is filed.

A nursing facility may request an undue hardship waiver on an individual’s behalf with the consent of the individual or their designated representative. 1640.0307.06 Processing Undue Hardship Requests for Excess Home Equity (MSSI) When it is determined that an individual has equity interest in his/her home that exceeds the home equity interest standard in Appendix A-9, and the individual’s spouse, minor child, or blind or disabled child does not reside in the home, the individual must be notified and offered an opportunity to waive the policy. Mail form CF-ES 2354, Notice of Excess Home Equity Interest, to the individual and designated representative, informing the individual to contact the eligibility specialist within fifteen days to discuss the matter. The eligibility specialist will include his/her office phone number, rather than the Customer Call Center number.

If contacted by the individual, designated representative, or legal representative, use the Waiver of Home Equity Interest Questionnaire (CF-ES 2345A) as a guide to interview the individual and record the individual’s statement on the form.

Request from the individual any additional documentation (such as legal documents, realtor agreements, relevant correspondence, statements from other individuals) needed to substantiate the individual’s statements during the interview.

Evaluate the Questionnaire and any supporting documentation presented using form CF-ES 2357, Rebuttal/Undue Hardship Evaluation, and form instructions. If the home equity limit is not waived because the individual’s spouse, minor child, or blind or disabled child does not reside in the home, complete Part II (Undue Hardship Evaluation) of form CF-ES 2357and forward the evaluation form and documentary evidence to the Region or Circuit Program Office for review and signature approving or denying hardship. All undue hardship claim decisions must be reviewed by the Region or Circuit Program Office.

The evaluation must be completed within 10 calendar days following the interview date, not considering individual delay days. The Region or Circuit Program Office will communicate the decision to the eligibility specialist and return all documents. The eligibility specialist will complete the case on FLORIDA based on the outcome of the evaluation. 1640.0308 General Availability (MSSI, SFP) Once the individual's ownership interest of an asset(s) is established, the availability of that asset must be determined. Asset(s) determined not to be available are not considered in determining eligibility on the factor of assets.