A.
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, and
ii. 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 EXEMPTION
MaineCare 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*; or
b. 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; or
c. 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; or
d. 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.
