Background
Hildegarde Cvetkovic applied for Medicaid nursing-home coverage in May 2022 through her son acting under a power of attorney. The application said she had made no disqualifying transfers, but the county later found an uncompensated transfer during the statutory look-back period and imposed a transfer-penalty period. Its June notice granted limited coverage and explained the right to seek an undue-hardship waiver.
Cvetkovic did not apply for a waiver until January 25, 2023. The county granted relief effective October 1, 2022—three months before the application month—but not back to the beginning of her nursing-home stay. She and the facility challenged that date in a transferred CPLR article 78 proceeding, arguing that the agency should have evaluated hardship on its own and that notice defects required broader relief.
The Court’s Holding
The Fourth Department confirmed the Department of Health determination. Social Services Law § 366 and the implementing directives contemplate an application for an undue-hardship waiver supported by proof from the applicant. A local agency need not raise and decide hardship sua sponte when the Medicaid applicant neither requests a waiver nor submits the facts needed to establish it.
Once a person already receiving limited coverage applies during a transfer-penalty period, the governing administrative directive permits the waiver to reach no more than three months before the application month. Because Cvetkovic waited until January 2023, October 1 was the correct effective date. She could have requested hardship with the original Medicaid application or promptly after the June notice.
The panel acknowledged that the county did not send every required notice at the ideal time, but found no prejudicial deprivation of due process. The June notice explained the transfer presumption, rebuttal opportunity, and waiver procedure. Petitioners identified no evidence they would have offered to rebut the presumption and no reason for the later delay. Without prejudice to a substantial right, the omission did not justify annulment.
Key Takeaways
- A Medicaid nursing-home applicant must affirmatively request an undue-hardship waiver and provide supporting proof; the agency need not initiate the inquiry.
- For a later waiver application during limited coverage, relief ordinarily extends only three months before the application month.
- An agency notice defect does not automatically annul a determination when the claimant had a meaningful later opportunity and cannot show prejudice.
Why It Matters
This is a practical deadline decision for New York elder-law lawyers, nursing facilities, and families. Asset-transfer issues should be investigated before the Medicaid filing, and any hardship request should accompany the application when possible. Waiting after notice can create an unrecoverable coverage gap even if hardship is ultimately established.
Facilities assisting residents should calendar both fair-hearing and hardship-waiver deadlines, preserve proof of efforts to recover transferred assets, and document threats to health or shelter. Article 78 counsel should connect any procedural defect to evidence or arguments the applicant lost the chance to present; a technical notice violation alone may not produce relief.
The opinion distinguishes eligibility, transfer penalties, and hardship relief. A person may be financially eligible for some Medicaid coverage yet remain temporarily ineligible for institutional services because of an uncompensated transfer. The hardship waiver is a separate safety valve, not an automatic part of every eligibility decision. That structure explains why the applicant bears the burden to request and substantiate it.
A robust hardship submission should address the transfer, attempts to recover the asset, the resident’s available income and resources, the facility’s position, and the risk that denial will deprive the resident of medical care, food, clothing, shelter, or other necessities. Filing quickly matters as much as proof because the administrative retroactivity rule can leave earlier months outside the waiver even after the merits are accepted.