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North Carolina Department of Health and Human Services AGED, BLIND AND DISABLED MEDICAID MANUAL MA-2245
UNDUE HARDSHIP WAIVER FOR TRANSFER OF ASSETS
REVISED 11/01/11 – CHANGE NO. 17-11 (III.)
E. Send a DMA-5114, Request for Documentation for Undue Hardship Claim, within 5 work days of receipt of a request for a waiver.
1. Also send the DMA-5097/DMA-5097s, Request for Information. Document in the record the date the request is sent. Retain a copy of both the DMA- 5114 and the DMA-5097. The individual has 12 calendar days from the date of the notice to provide the information/documentation.
2. If information/documentation is not received by the end of the 12 calendar day period, send a second DMA-5114, Request for Documentation for Undue Hardship Claim, and DMA-5097/DMA-5097s, Request for Information. Document in the record the date the request is sent. Retain a copy of both the DMA-5114 and the DMA-5097. Allow an additional 12 calendar days to submit the information/documentation.
3. If information/documentation is not received by the end of the second 12 calendar day period:
a. For applications, continue to hold through the end of the application processing period and if not received at that time, deny the undue hardship waiver request for failure to provide information/documentation. Send a DSS-8109/DSS-8109S, Notice of Benefits, Denied or Withdrawn, using the appropriate notice text code.
b. For individuals who already receive Medicaid coverage of institutional services, send a timely notice to the individual at the end of the second 12 calendar day period.
c. For pla recipients who apply for institutional services, send a DSS- 8109/DSS-8109S, Notice of Benefits, Denied or Withdrawn, using the appropriate notice text code to deny the request for those services.
4. If information/documentation is received within the requested time period, evaluate for undue hardship. See III.G. below.
F. For Medicaid applications, when all other information to determine eligibility is received, and only the documentation for an undue hardship is needed, follow procedures in MA-2304, Processing the Application. Exclude time with a “WVR” exclusion code entry on the Date Screen in EIS. (See EIS-2400, Date Screen) Do not exclude time with “WVR” if the applicant is otherwise pla eligible.
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