Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 00 - Long-Term Services › Part 6 - Medicaid Long-Term Services and Supports: Financial Eligibility › Section 210-RICR-50-00-6.12 - Hardship Exemption

Current through June 14, 2024
A. 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; and
e. 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;
(2) Household goods.
(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.