Policy:

317:35-9-67 DDS Waiver
317:35-17-10 ADvantage
317:35-5-41.8 Eligibility regarding long-term care services

Who submits hardship decisions?

The Adult & Family Services (AFS) Family Services Specialist prepares the request for a hardship decision (as opposed to: Nursing Home, APS, Family, etc.) after staffing with Supervisor, and the Supervisor submits to AFS HRMS.

Who makes hardship decisions?

State Office; AFS/HR&MS must make the hardship decisions.

When do I request a hardship?

When application of a transfer of assets penalty would deprive the individual of medical care such that the individual’s health or life would be endangered or the applicant would be deprived of food, clothing, shelter, or other necessities of life.

An undue hardship does not exist if the individual willingly transferred assets for the purpose of qualifying for SoonerCare services through the use of the undue hardship exemption.

Request a hardship when it appears exploitation of the client caused the transfer of assets, and assessing a penalty period will deprive the individual of long term medical care services. Legal action must be pursued to return the transferred assets to the applicant before a hardship waiver decision can be granted.  Pursuing legal action means an Adult Protective Services (APS) referral has been made to the district attorney’s office recommending prosecution of the perpetrator or a lawsuit has been filed and is being pursued against the perpetrator.

How do I request a hardship decision?

Supervisor submits an email to AFS.HRMS@okdhs.org to obtain a decision. Please cc the AFS/HR&MS LTC PFR JC Dempsey, at JC.Dempsey@okdhs.org Please include the name, case number, and Hardship Waiver Request to the subject line of the email.

The request needs to tell the story in detail. The following questions will need to be addressed before a decision can be made.

• What is the Medicaid application date?
• What has been done to stop the issues?
• When was the perpetrator’s access to income and resources terminated?
• When did new payee apply to become new payee of client’s income and when did they start receiving the income?
• If APS referral was made a copy of the completed APS-2 must be submitted.
• Does APS have guardianship? If so, provide documentation
• What is the date client is “otherwise eligible” had it not been for the transfer?
• If client or their representative is pursuing legal action through the district attorney’s office or a lawsuit has been filed against the perpetrator, documentation must be submitted. This includes correspondence from their attorney, petitions, police reports and orders, if any.

An undue hardship does not exist if the individual willingly transferred assets for the purpose of qualifying for SoonerCare services through the use of the undue hardship exemption. Such determination should be referred to OKDHS State Office for a decision.