Current through all regulations passed and filed through September 16, 2024
(A) This rule describes an undue hardship
exemption for institutionalized individuals who are subject to a restricted
medicaid coverage period (RMCP) described in rule
5160:1-6-06.5 of the
Administrative Code.
(B) The
institutionalized individual will not be subject to
an RMCP
when the
imposition of the RMCP would cause an undue hardship.
(C) An undue hardship exists
when the
imposition of the RMCP would deprive the institutionalized individual of:
(1) Medical care such that the
institutionalized individual's health or life would be endangered; or
(2) Food, clothing, shelter, or other
necessities of life.
(D)
An undue hardship exemption may be requested by:
(1) The institutionalized individual;
or
(2) The institutionalized
individual's spouse; or
(3) A
person, including a court or administrative body, with legal authority to act
in place of or on behalf of the institutionalized individual or
the
individual's spouse; or
(4) A
person, including any court or administrative body, acting at the direction or
upon the request of the institutionalized individual or
the
individual's spouse.
(E) Any request for an undue hardship
exemption must be made in writing and include the information and documentation
necessary to demonstrate to the administrative agency that:
(1) An undue hardship exists.
(2) The institutionalized individual
currently has no alternative income or resources available to provide the
medical care or food, clothing, shelter, or other necessities of life that the
institutionalized individual would be deprived of due to the imposition of the
RMCP.
(3) A
good faith effort to pursue all reasonable means to recover the transferred
asset or the fair market value of the transferred asset was made, unless
documentation provided shows that the cost of any such action would exceed the
gross value of the assets subject to recovery. These actions may include:
(a) Seeking the advice of an attorney and
pursuing legal or equitable remedies such as asset freezing, assignment, or
injunction; or seeking modification, avoidance, or nullification of a court
order, financial instrument, promissory note, loan, mortgage or other property
agreement, or other similar transfer agreement; and
(b) Cooperating with any attempt to recover
the transferred asset or the fair market value of the transferred asset.
(F) An undue hardship exemption shall not be
granted
when the institutionalized individual, or
the
individual's spouse, or anyone acting on their behalf, made the improper
transfer after a previous request for a hardship exemption.
(G)
Administrative agency responsibilities.
(1)
The administrative agency shall provide notice to the institutionalized
individual of the:
(a) Availability of an
undue hardship exemption; and
(b)
Approval or denial of any
request for an undue hardship exemption.
(2) The administrative agency, on its own
initiative, may consult with the county prosecutor to determine whether a civil
or criminal action may be brought to recover the transferred assets or to
compel restitution.
