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Chapter: 1600 Assets Program: MSSI, SFP 54

The presence of one or more of the following factors may indicate that assets were transferred exclusively for some purpose other than establishing eligibility:

1. Total included assets were below the asset limit at all times from the month of transfer through the present month even if the transferred asset had been retained. 2. A court ordered transfer. 3. Exploitation (another person stole the funds of the individual).

This list is not all inclusive. 1640.0617 Undue Hardship (MSSI) When application of the transfer of assets or income provisions discussed in this chapter would cause an undue hardship on the applicant/recipient, the transfer provisions do not apply.

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, shelter, food, or clothing 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 of the potential application of the penalty period.

A nursing facility may request an undue hardship waiver on an applicant/recipient’s behalf, with the consent of the individual or their designated representative. 1640.0618 Period of Ineligibility (MSSI) When the presumption that a transfer was made to become Medicaid eligible is not successfully rebutted and the hardship claim denied, determine the period of ineligibility.

The penalty period depends on:

1. the amount of the Uncompensated Value (UV), 2. when the transfer occurred, and 3. the average private nursing home cost at the time of application or discovery of the transfer.

The following basic formula is used to determine the period of ineligibility on all applicable cases:

Uncompensated value divided by the average private nursing home rate equals the number of months of ineligibility.

For assets transferred before 11/1/07: Add all uncompensated values together that occur in the same month. Determine the potential penalty period for each month’s total UV, rounding down to the nearest whole month. Where assets have been transferred in amounts and/or frequency that would make the calculated penalty period of one month overlap the penalty period of another, the values of all assets from months with overlapping penalty periods are added together and divided by the average cost of private nursing home care.

Where multiple transfers are made in such a way that the penalty periods for each would not overlap, each transfer is treated as a separate event with its own penalty period.