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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.)

G. The county director of social services or his designee makes the decision on undue hardship within 12 calendar days of receipt of the information/ documentation.

H. If the Director or Director’s designee identifies the need for additional information and/or documentation, request the additional information/ documentation. Use DMA-5114, Request for Documentation for Undue Hardship Claim, along with a DMA-5097/DMA-5097s, Request for Information. Document in the record the date the request is sent and retain a copy. The individual has 12 calendar days from the date of the notice to provide the information/documentation.

1. If the additional 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, along with a DMA-5097/DMA- 5097s, Request for Information. Allow 12 additional calendar days to submit information/documentation.

2. Complete the determination within 12 calendar days of receipt of the additional information.

3. If the additional information is not received within the period described in III.H. and III.H.1. above, deny the undue hardship request as described in III.E.3.above.

IV. INFORMATION AND DOCUMENTATION TO SUPPORT CLAIM FOR UNDUE HARDSHIP

The burden of proof to show that an undue hardship exists is the responsibility of the a/r or some other person or institution acting on the a/r’s behalf.

Documentation from the a/r or the person or institution acting on the a/r’s behalf must include:

A. A written statement from a medical doctor with knowledge of the a/r’s medical condition certifying that in his or her professional opinion, the a/r will be in danger of death or the a/r’s health will suffer irreparable harm if a penalty period is imposed.

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