Subsection 144-101-VII-5.08 - WAIVERSA.UNDUE HARDSHIP WAIVER An applicant may request a waiver of a claim under§5.03(B) if enforcement of the claim would cause an undue hardship for the applicant.
Eligibility criteria for an undue hardship waiver: The applicant must demonstrate they have a beneficial interest in the estate and that the applicant is dependent upon the assets of the estate, as defined below.
1.Dependence upon Estate Assets: The applicant must demonstrate their financial circumstances require them to rely upon the assets of the estate by meeting one of the following criteria: a. The estate assets or property received by survival or distribution are part of a business, including a working farm, i. upon which the applicant was dependent for applicant's livelihood during the decedent's lifetime, andii. the recovery of which by the Department would deprive the applicant of their sole means of livelihood, or
b. The applicant's household income and asset level combined is less than 180% of the Federal Poverty Income level. The request shall contain a written statement of the circumstances constituting the hardship and all supporting documentation. The income and asset level of the applicant for the 52 weeks preceding the Member's death plus the applicant's income and assets at the time of application shall be used to determine waiver eligibility. The Department may also request the applicant's previous two years of income preceding the Member's death and any other financial information that may support the application. B.UNDUE HARDSHIP WAIVER BASED ON CARE GIVEN EXEMPTIONMaineCare may exempt a portion of a Member's estate from estate recovery for health maintenance activities and personal care services performed for the Member by one individual who has a beneficial interest in the Estate. If the current income level of the waiver applicant is below two hundred percent (200%) of the current Federal Poverty Income Level, adjusted for the person's household size, MaineCare may designate a portion of a Member's estate as exempt from its estate recovery efforts if a person can demonstrate that health care maintenance activities or personal care services have been provided to a Member, as outlined below:
1. The applicant requesting the care given exemption provided health maintenance activities or personal care services as defined herein to the decedent during part or all of the two (2) years immediately prior to the Member's death or institutionalization, enabling the decedent to remain at home and avoid institutionalization for an equivalent period of time. The person requesting the exemption must provide corroborating statements from the decedent's primary care physician or other approved medical care provider acceptable to MaineCare. 2. Any care given exemption granted will not exceed the value of MaineCare benefits paid on behalf of the Member, which would otherwise be subject to Estate Recovery. Following the approval of the undue hardship waiver based on a care given exemption, the Department will use one of the following formulas to determine the exempt amount: a. If the decedent received 24 hour a day care including health maintenance and personal care activities defined in Sections 5.02-6 and 5.02-12, that enabled the decedent to remain at home and avoid placement in institutional care as described in Section 5.02-8, and MaineCare was not paying for in home services at the time, the Department may grant an exemption not to exceed thirty-two thousand dollars ($32,000) per year, prorated for each month of approved care given*; orb. If the decedent received care including personal care services and/or health maintenance activities less than those services he or she would have received in institutional care as described in Section 5.02-8, the Department may grant an exemption not to exceed twelve thousand dollars ($12,000) per year, pro-rated for each month of approved care given; orc. If the decedent received approved care for three (3) or more health maintenance or personal care activities defined in Section 5.02 everyday, the maximum exemption of twelve thousand dollars ($12,000) per year may be granted; ord. If the decedent received approved care for three (3) or more health maintenance or personal care activities defined in Section 5.02 at least three (3) times per week, a maximum exemption of six thousand dollars ($6,000) per year may be granted. These allowances are in place to assist the Member in maintaining independent living at home and reduce overutilization of institutional services. In circumstances where an applicant may qualify for more than one level of care, the highest amount for one application will be granted.
3. Health care maintenance activities or personal care services previously used during the application process to reduce a transfer of assets cannot be counted again toward a care given exemption or a claim reduction. 4. All care given exemptions will be based on and limited to the two (2) year time period immediately prior to the Member's death or institutionalization. 5. An applicant may not be granted a waiver pursuant to this section for any services rendered to a Member and for which the applicant received compensation, either monetary or non-monetary. C.M.R. 10, 144, ch. 101, ch. VII, 144-101-VII-5, subsec. 144-101-VII-5.08