P804 How to Refer an Undue Hardship for Trust Policy

Program	Manual Section
ALTCS	MA804

Procedures

Once a trust has been reviewed and its treatment determined, the result may be income or resource ineligibility. When the customer requests a determination of undue hardship, follow the steps below to review and elevate the undue hardship request:

Step	Action
1	Does the customer meet all other eligibility requirements, and is ineligible only because of trust policy? If YES, continue to step 2. If NO, STOP. Undue Hardship does not apply. Explain the trust and other policies that are not met to the customer.
2	Is the customer’s income at or below 100% of the FPL? If YES, skip to step 4. If NO, continue to step 3.
3	Did the customer provide proof of uncovered medical needs or expenses that supports the claim of undue hardship during the application process or with the undue hardship request? If YES, continue to step 4. If NO, send an edited RFI requesting the proof needed and continue to step 4 if the proof is received.
4	Submit a policy clarification request. In the PCR, describe the trust policy that is causing ineligibility and the location of the proof supporting the claim in the case file. This may include any of the following: Proof of the customer’s income at or below 100% FPL; Proof of medically necessary services that would be the customer’s responsibility if ALTCS is not approved; and Proof of the customer’s other benefits and insurance that do not cover the customer’s needs.