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ASSET TRANSFER UNDUE HARDSHIP CLAIM FORM Return To Agency Address Case Name Case Worker Name Worker Telephone The opportunity to claim an Undue Hardship must be offered when the imposition of a penalty period for the uncompensated transfer of assets affects Medicaid payment for long-term care services including nursing facility PACE hospice or community-based care CBC. An undue hardship may be granted when documentation is provided that shows the assets transferred cannot be recovered and the immediate adverse impact of the denial or cancellation of Medicaid coverage would result in the individual being removed discharged from the nursing facility PACE hospice or CBC or becoming unable to receive life-sustaining medical care food clothing or shelter. The request for an Undue Hardship and all documentation must be submitted to the eligibility worker at the local department of social services. The Department of Medical Assistance Services will review the documentation provided with the u....

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232