Ohio Admin. Code 5160:1-6-06.6 - Medicaid: undue hardship exemption
describes an undue hardship exemption for institutionalized individuals who are
subject to a restricted medicaid coverage period (RMCP) described in rule
5160:1-6-06.5 of the Administrative Code.
institutionalized individual will not be subject to a RMCP if the imposition of
the RMCP would cause an undue hardship.
An undue hardship
exists if the imposition of the RMCP would deprive the institutionalized
Medical care such that the institutionalized
individual's health or life would be endangered; or
shelter, or other necessities of life.
An undue hardship
exemption may be requested by:
The institutionalized individual; or
institutionalized individual's spouse; or
including a court or administrative body, with legal authority to act in place
of or on behalf of the institutionalized individual or his or her spouse;
A person, including any court or administrative body,
acting at the direction or upon the request of the institutionalized individual
or his or her spouse.
Any request for
an undue hardship exemption must be made in writing and include the information
and documentation necessary to demonstrate to the administrative agency
undue hardship exists;
The institutionalized individual currently has no
alternative income or resources available to provide the medical care or food,
clothing, shelter, or other necessities of life that the institutionalized
individual would be deprived of due to the imposition of the RMCP;
A good faith effort to pursue all reasonable means to
recover the transferred asset or the fair market value of the transferred asset
was made, unless documentation provided shows that the cost of any such action
would exceed the gross value of the assets subject to recovery. These actions
Seeking the advice of an attorney and pursuing legal or
equitable remedies such as asset freezing, assignment, or injunction; or
seeking modification, avoidance, or nullification of a court order, financial
instrument, promissory note, loan, mortgage or other property agreement, or
other similar transfer agreement; and
any attempt to recover the transferred asset or the fair market value of the
institutionalized individual resides in a LTCF, in addition to the requirements
in paragraphs (E)(1) to (E)(3) of this rule, the institutionalized individual
must also show that:
The LTCF has planned to discharge the institutionalized
individual as a result of the imposition of the RMCP; and
institutionalized individual has exhausted all administrative remedies to
challenge the planned discharge.
An undue hardship
exemption shall not be granted if the institutionalized individual, or his or
her spouse, or anyone acting on their behalf, made the improper transfer after
a previous request for a hardship exemption.:
The administrative agency shall provide notice to the
institutionalized individual of the:
Availability of an undue hardship exemption;
Any approval or denial of any request for an undue
administrative agency, on its own initiative, may consult with the county
prosecutor to determine whether a civil or criminal action may be brought to
recover the transferred assets or to compel restitution.
Replaces: 5160:1-3- 07.2
Promulgated Under: 111.15
Statutory Authority: 5163.02, 5160.02
Rule Amplifies: 5160.02, 5163.02
Prior Effective Dates: 9/3/77, 7/1/82, 7/15/84, 1/1/85 (Emer.), 4/1/85, 11/1/86 (Emer.), 12/22/86, 7/1/87 (Emer.), 8/3/87, 1/1/90(Emer.), 4/1/90, 10/1/90, 4/1/95 (Emer.), 6/11/95, 3/15/96 (Emer.), 6/1/96, 11/7/02, 10/20/06, 1/1/16
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