Page 9

North Carolina Department of Health and Human Services AGED, BLIND AND DISABLED MEDICAID MANUAL MA-2245

UNDUE HARDSHIP WAIVER FOR TRANSFER OF ASSETS

9

ISSUED 11/01/07 – CHANGE NO. 24-07 (V.)

D. If it is determined that an undue hardship does not exist, deny the request for the waiver. Send a manual DSS-8109/DSS-8109s, Your Application for Benefits are Being Denied or Withdrawn, stating denial of the request for undue hardship for Medical Assistance coverage of institutional services and the reason for the denial. Impose the transfer of asset penalty sanction.