UNDUE HARDSHIP
Undue hardship is when a sanction period for Medicaid eligibility imposed due to a transfer of
assets causes you to be deprived of:
• Medical care causing your life to be endangered, or
• Food, clothing, shelter, or other necessities of life.
You must have no other sources available to provide medical care, food, clothing, shelter, or
other necessities of life.
You or a person or facility acting on your behalf is making a good faith effort to pursue all
reasonable means to recover the transferred asset or the fair market value of the transferred
asset.
Some documentation that may be supplied includes but is not limited to those listed below:
• Your doctor certifies in writing that in his/her professional opinion that denial of payment for
nursing facility services will cause danger to your health or even death, or
• You have statements from persons who have knowledge of your situation (for example:
doctors, nurses, social workers or family members) to show that the application of a penalty
would deprive you of food, clothing, shelter, or other necessities of life, and
• You have documentation to show that you have pursued available legal or equitable
remedies to recover the asset or the fair market value of the asset, and
• You can demonstrate with documentation that the transferred asset(s) are beyond your
control and can not be recovered.
You can ask for a hearing
If you think we are wrong or you have new information, you have the right to a hearing. You
must ask for this hearing within 60 days (or 90 days if you have a good reason for delay). This
hearing is a meeting to review your case and give you the correct benefits if it was wrong.
Call or write your caseworker to ask for a hearing. A local hearing will be held within 5 days of
your request unless you ask for it to be postponed. The hearing can be postponed, for good
reasons, for as much as 10 calendar days. Then, if you think the decision in the local hearing
is wrong, call or write your caseworker WITHIN 15 DAYS to ask for a second hearing. The
second hearing is before a state hearing official.
You have the right to see your record
If you ask, your caseworker will show you (or the person speaking for you) your benefits record
before your hearing. If you ask, you may also see other information to be used at the hearing.
You can get free copies of this information. You may see this information again at your
hearing.
If you have additional questions or concerns, contact your caseworker for information, or
call the CARE-LINE, Information and Referral Service, toll free at 1-800-662-7030. If you live
in the Raleigh area, call 919-855-4400. TDD/Voice for the hearing impaired is also available
through the CARE-LINE number. Their hours of operation are 8 am to 5 pm, Monday through
Friday.
DMA-5113 (
11/07)
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