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c. Owns as a tenancy in common interest of at least 25% in the real property which is valued at less than $100,000.

d. Acquired the interest at least 24 months prior to the Medicaid beneficiary’s death, and

e. Has gross income available to them and their spouse and related family members in his or her household which is below 200% of the federal poverty level and

f. Has assets and their spouse and related family members in their household have assets, excluding the qualified undue hardship applicant’s tenancy in common interest in the residence, valued below twenty-five thousand dollars ($25,000)

G. Duration of Undue Hardship Waiver or Deferral

An undue hardship waiver or deferral applies only during the lifetime of the qualified undue hardship applicant and only as long as the qualified undue hardship applicant continues to meet the criteria of one of the undue hardship definitions.

VI. CLAIM OF UNDUE HARDSHIP

A claim of undue hardship must be made within 60 days of the date of the notice of the Medicaid claim. A claim of hardship must describe the financial circumstances of the surviving heir, and/or their dependents in the estate. The estate recovery administrator evaluates each claim of hardship based on documentary evidence submitted by the claimant. Inform the personal representative to submit a hardship claim to:

Division of Health Benefits HMS Estate Recovery Unit PO Box 18869 Raleigh, North Carolina 27619-8869

A. Documentary Evidence

Inform the personal representative to contact the Division of Health Benefit’s Estate Recovery Administrator at (888) 245-0179 for a list of the documents that may be required for an undue hardship claim.

B. Hardship Claim Decision

Each claim of undue hardship is evaluated within 90 calendar days from the date of receipt of a complete application and all necessary documentation. A written decision is made within 10 calendar days after completing the review. If the surviving heir disagrees with the decision on a claim of hardship, they may appeal to the Office of DocuSign Envelope ID: FDC5A36F-C20D-40ED-8E94-3167F2A747A6 DocuSign Envelope ID: 9CB30F35-4CFE-41A3-8663-00DA59A946C6