The Hardship Exception to the Medicaid Penalty Period: Rare But Possible

If you transfer assets within five years of applying for Medicaid, you will likely be subject to a period of ineligibility. There is an exception, however, if enforcing the penalty period would cause the applicant an "undue hardship." This exception is difficult to prove and rarely granted, but it may be possible in certain circumstances.

Under federal Medicaid law, the state Medicaid agency must determine whether a Medicaid applicant transferred any assets for less than fair market value within the past five years. If there are any transfers, the state imposes a penalty period, which is a period of time in which the applicant will be ineligible for Medicaid benefits.

A Medicaid applicant can fight the penalty period by arguing that enforcing the penalty period will cause the applicant an undue hardship. Federal law provides that an undue hardship exists if the penalty period would deprive the applicant of (1) medical care necessary to maintain the applicant's health or life or (2) food, clothing, shelter, or necessities of life. The burden is on the applicant to prove that hardship exists. A nursing home can also pursue a hardship waiver on behalf of a resident.

Proving an undue hardship is difficult because the applicant needs to show that he or she can't afford nursing home care during the penalty period and that without nursing home care, the applicant's health will decline. In addition, states are free to define "hardship" as they see fit and courts vary on how they enforce the hardship exception. For example, in Matter of Tarrytown Hall Care Ctr. v McGuire (N.Y. Sup. Ct., App. Div., 2nd Dept., No. 2849/12, April 16, 2014), a New York appeals court ruled that an undue hardship exception applied even though the nursing home did not attempt to evict the applicant because she was insolvent and unable to recover the assets, and because no other nursing home would accept her. On the other hand, in R.P. v. Division of Medical Assistance and Health Services (N.J. Super. Ct., A.D., No. A-6148-11T3, Oct. 22, 2013), a New Jersey appeals court ruled that a Medicaid applicant whose son had transferred the applicant's assets to himself was not entitled to an undue hardship exception because the applicant had not proven his health or life were endangered.

If you believe you are entitled to an undue hardship waiver, contact your attorney.

For more information about Medicaid, click here. 

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