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Application for Undue Hardship Exception to Medicaid Ineligibility Should Have Been Granted

The Second Department determined the Department of Health (DOH) should have granted a nursing home’s (Tarrytown Hall’s) application for an undue hardship exception to Medicaid Ineligibility:

An individual will not be ineligible for Medicaid as a result of a transfer of assets if it is determined that the denial of eligibility will result in an undue hardship. An undue hardship occurs where the institutionalized individual is otherwise eligible for Medicaid, is unable to obtain appropriate medical care without the provision of Medicaid, and is unable to have the transferred assets returned (see 18 NYCRR 360-4.4).Here, the DOH’s determination that Tarrytown Hall failed to demonstrate undue hardship is not supported by substantial evidence. To the contrary, Tarrytown Hall established that the decedent was otherwise eligible for Medicaid, and further established that she was unable to obtain appropriate medical care without the provision of Medicaid by offering proof that the decedent was insolvent and unable to recover transferred assets, and that no nursing facility which could provide her with the necessary level of care would accept her. By offering this proof, Tarrytown Hall met the statutory and regulatory requirements for the undue hardship exception. Matter of Tarrytown Hall Care Ctr v McGuire, 2014 NY Slip Op 02600, 2nd Dept 4-16-14

 

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