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Division of Welfare and Supportive Services F-435.2 Medical Assistance Manual TRANSFER OF ASSETS 23 Oct 01 MTL 04/23 REBUTTAL through (f) and as described on Form 2601. If the customer fails to address a point or points, advise the customer which point(s) must be addressed before a decision can be made.

Upon receipt of the information, send the rebuttal to the Chief of Eligibility and Payments requesting a decision on whether a transfer of assets occurred and include a Form 6009 with the following information:

a. The name and case number of the applicant/recipient;

b. The application date;

c. The date the customer began receiving HCBW of LTC Services;

d. A brief description of the circumstances of the transfer; and

e. Verification of the Fair Market Value of the asset at the time of transfer.

F-435.3 Undue Hardship

If undue hardship is claimed, the individual will be responsible for providing convincing evidence the penalty period would cause an undue hardship. The evidence must include:

a. A written statement from the customer/authorized representative, or facility staff person (upon consent of the individual or the individual’s authorized representative) stating the reason they feel undue hardship applies;

b. Verification, if possible, there is no means, legal or otherwise, by which the customer is able to have the asset transferred back to his/her ownership or receive further compensation; and

c. The customer’s relationship, if any, to the person(s) to whom the asset was transferred.

Denial of eligibility would cause an undue hardship against the individual when all of the following conditions exist:

a. The customer is otherwise eligible for Medicaid; and

b. The customer has insufficient funds to cover the cost of institutionalized care; and

c. The person(s) who has/have the asset(s) has refused to make the asset(s) available to the customer; and