MA907

Are the transfers in HEAplus from AVS flagged decreases?

• If YES, continue to step 2.

• If NO, skip to step 4.

Has the customer provided the bank statements and an explanation for the flagged decreases?

• If YES, continue to step 3.

• If NO, STOP. Review the rebuttal and exclusion reasons with the customer. Request the bank statements. Inform the customer that proof of the transfers and any compensation received must be provided before the undue hardship request can be made. If proof is unavailable, the customer must provide a statement explaining all the ways that the customer tried to get the proof.

Have all rebuttal reasons been explored with the customer and proof of any compensation, rebuttal reasons, or exclusion reasons collected?

• If YES, continue to step 4.

• If NO, review the rebuttal reasons with the customer. Inform the customer that proof must be provided before the undue hardship request can be made. If proof is unavailable, the customer must provide a statement explaining all the ways that the customer tried to get the proof.

Does the customer qualify for full ALTCS except for the transfer penalty?

• If YES, continue to step 5.

• If NO, STOP. Undue hardship does not apply.

Has the application been dispositioned, and the transfer penalty applied?

• If YES, continue to step 6.

• If NO, STOP. Process the application. If the customer inquired about undue hardship, inform the customer that they will get a decision letter with information about requesting undue hardship.

Do you have proof that the customer was mentally competent at the time of the transfer and would have been aware of the consequences of the transfers at the time the transfers occurred?

• If YES, skip to step 11.

• If NO, continue to step 7.

Do you have proof that the customer was mentally competent and gave another person the legal authority to make the transfers and that person did not violate the limits of that authority in making the transfers?

• If YES, skip to step 11.

• If NO, continue to step 8.

Do you have proof that the customer’s income is below 100% of the Federal Poverty Level (FPL)?

• If YES, skip to step 11.

• If NO, continue to step 9.

Is there proof to suggest that the customer’s life or health would be endangered if full ALTCS is not approved?

• If YES, skip to step 11.

• If NO, continue to step 10.

Do you have proof of all the following requirements met for a person violating their legal authority?

• The customer is incapacitated as determined by a court or physician; and

• Someone with the legal authority to handle the customer’s finances, violated the terms of that authority; and

• Someone acting on behalf of the customer exhausted all legal remedies to get the asset back, including filing a police report and seeking recovery through civil court.

  • If YES, the customer may be eligible for undue hardship, continue to step 11.

  • If NO, undue hardship does not apply. If the customer already made the undue hardship request continue to step 11.

Place the proof for the undue hardship into DocuWare and continue to step 12.

Create a Policy Clarification Request (PCR) in Policy Assignment Tracking System (PATS) for the undue hardship request. In the body of the PCR describe your findings from this procedure and the types of proof provided.

When you get the PCR confirmation email, go back to DocuWare and enter the PCR number in the “PCRNUM.” field and place a note in the “Notes” field that says “Undue Hardship”.

Once the undue hardship decision is received, verbally inform the customer of the decision.