Medicaid Applicant Not Entitled to Hardship Waiver Because No Showing That Medicaid Would Be Only Care Source

A New York appeals court holds that a Medicaid applicant found to be ineligible due to a transfer of assets is not entitled to an undue hardship waiver because she could not prove she would be unable to obtain medical care without Medicaid. Hall v. Zucker (N.Y. Sup. Ct., App. Div., 4th Dept., No. TP 20-01235, Feb. 4, 2022).

Josephine Hall applied for Medicaid benefits. New York State’s Medicaid agency determined that she was ineligible for benefits because her husband had transferred assets for less than fair market value within the look-back period.

Ms. Hall appealed, asking for an undue hardship waiver. Under state law, to be entitled to a hardship waiver, Ms. Hall had to show that she could not obtain medical care without Medicaid and that she was unable to have the transferred assets returned. After a hearing, the Medicaid agency denied her request for a waiver, and she appealed to court.

The New York Supreme Court, Appellate Division, Fourth Department, affirms the denial of Medicaid benefits, holding that Ms. Hall did not prove that she was entitled to a hardship waiver. According to the court, “there was no indication that [Ms. Hall] would be unable to obtain appropriate medical care if she did not receive” Medicaid. The court also notes that the Medicaid agency found it was not credible that Ms. Hall could not have the asset returned and that issues of witness credibility were for the agency to decide.

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