Section 210-RICR-50-00-6.12 - Hardship ExemptionA. The State has established a process in which applicants and beneficiaries may seek hardship exemption of certain Medicaid LTSS financial eligibility requirements.B. To qualify for an exemption, the Medicaid LTSS applicant or beneficiary must show that complying with the requirement poses an undue hardship. The criteria for determining undue hardship vary as follows:1. Jointly owned real property - The State may exclude otherwise countable real property, including a former primary residence, when it is jointly owned and the sale of the property by an applicant or beneficiary would cause the other owner(s) to lose housing. For this purpose, loss of housing is considered undue hardship if the property serves as the principal place of residence for one (1) (or more) of the other owners, its sale would result in loss of that residence, and no other alternative and appropriate housing is readily available for the displaced other owner. If such undue hardship ceases to exist, the property becomes a countable resource.2. Excess equity in a home - The State may waive denial of the home exclusion due to excess equity value in the principal place of residence if undue hardship exists. The applicant or beneficiary must provide evidence that ineligibility for Medicaid LTSS based on denial of the home exclusion: a. Risk to personal health or safety. The loss of Medicaid LTSS prevents access to or the continuation of services and supports necessary to ensure the health and safety of the applicant or beneficiary is not in jeopardy;b. Deprivation. Evidence must be provided that without Medicaid LTSS the applicant or beneficiary would be deprived of food, shelter, clothing, or other necessities required to sustain personal health and safety;c. Prospective termination. The current LTSS provider has notified the applicant or beneficiary of the intent to initiate a discharge or cease providing services and supports; or prospective LTSS providers are unwilling to start services due to the lack of Medicaid coverage;d. No alternative. There is not an affordable option to Medicaid LTSS coverage available that meets the needs of the applicant/beneficiary; ande. Intent to live or return. The applicant or beneficiary lives in the home or intends to return to the home as required pursuant to § 6.3(B) of this Part.3. Transfer penalty - An applicant or beneficiary may request a hardship exemption of the penalty period of Medicaid LTSS eligibility. Undue hardship exists when the applicant or beneficiary provides proof that: a. Risk to personal health or safety. The loss of Medicaid LTSS prevents access to or the continuation of services and supports necessary to ensure the health and safety of the applicant or beneficiary is not in jeopardy;b. Recovery fails. All available strategies for recovering the asset(s) conveyed in a disqualifying transfer have been exhausted without success;c. Prospective termination. The current LTSS provider has notified the applicant or beneficiary of the intent to initiate a discharge or cease providing services and supports; or prospective LTSS providers are unwilling to start services due to the lack of Medicaid coverage;d. No alternative. There is not an affordable option to Medicaid LTSS coverage available that meets the needs of the applicant or beneficiary.e. Limited other resources. The applicant or beneficiary must have minimal remaining available resources after the CSRA is completed, if appropriate, as indicated in §6.5.2 of this Part. For this purpose, the remaining resources must be less than the monthly statewide average cost of nursing facility services to a private pay-resident, excluding the value of: (1) The primary residence, but only if the home exclusion in §6.5.3(B) of this Part applies;(3) A vehicle required by the applicant or member for transportation.(4) Funds for burial of four thousand dollars ($4,000.00) or less.f. COVID-19 Public Health Emergency (PHE) Exemption. For one (1) year following the end of the Federally-declared COVID-19 PHE, nursing facility residents may claim a hardship exemption for penalty periods that would otherwise be imposed due to transferring up to ten thousand dollars ($10,000.00) of assets during the COVID-19 PHE. In order to qualify for this exemption, transferred assets must have been accrued through the temporary prohibition on Cost of Care. This exemption does not apply to the transfer of lump sum income received during this time. No hardship. Hardship will not be found if:
(1) The disqualifying transfer was made to a person who was handling the financial affairs of the applicant or beneficiary or to the spouse or children of such a person, unless proof is provided that the payments were used to pay for LTSS;(2) There is no satisfactory evidence showing that the applicant or beneficiary intended to dispose of the asset either at fair market value or for other valuable consideration equal to the fair market value. Attempts to sell the asset for fair market value must verified through an independent source;(3) The criteria for rebutting the determination of a disqualifying asset pursuant to §6.6.2 of this Part are not met;(4) Documentation is provided indicating that the person who made the disqualifying transfer has returned the assets subject to the penalty period of ineligibility.C. When claiming undue hardship, the applicant or beneficiary or an authorized person acting on his or her behalf must submit a written request and any supporting documentation including a statement from an attorney, if one was involved; proof of medical costs, and a statement from the trustee and/or transferee, if appropriate.210 R.I. Code R. 210-RICR-50-00-6.12
Adopted effective 1/20/2019
Amended effective 7/21/2021