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My Spouse Refuses to Get Medicaid. What are my Options?

Medicaid

If you are here, you have probably heard of government-subsidized health care but it can be difficult to distinguish between the various federally funded programs. So what is Medicaid? Created in 1965 alongside Medicare, Medicaid was part of Lyndon Johnson’s Great Society program. Since then, Medicaid has become an integral part of the American life.

Medicaid is a federal-state program that helps pay long term medical and custodial care costs.

Who is Eligible for Medicaid?

It is worth noting that the eligibility for Medicaid varies from state to state. During the early stages, Medicaid started as a program to take care of the health needs of people who were unable to work due to various reasons. It covered the blind, aged, disabled and single parent families. Over the years, Medicaid has expanded to cover more groups.

Medicaid Spousal Refusal

The Federal Medicaid law states that a community spouse is allowed to keep all of his or her assets by refusing to support his or her institutionalized spouse. This law portion is commonly referred to as “spousal refusal,” or “just say no.” It is generally used in Connecticut, New York, and Florida.

Although this policy has been recognized by federal law since 1988, the state of New York was the first to implement with Florida starting to observe it in 1999.

Typically, the healthy spouse also known as the community spouse, can keep all their assets. If such refusal occurs and the institutionalized spouse assigns their right to support from the community to the state, the state is obliged to give the institutionalized spouse medical coverage.

This option works best when the assets are already owned by the community spouse rather than transferring all assets to the community spouse before a Medicaid application is filled. When spousal refusal is implemented, the county worker evaluates all the assets titled in only the institutionalized spouse’s name. The government treats the institutionalized spouse as an individual for Medicaid purposes.

Spousal refusal restricts the Medicaid program from refusing to provide coverage to an eligible individual. However, just refusing is not enough to get the coverage. You should note that, as an applicant for Medicaid, you are required to assign to a program that his or her rights to enforce support obligations against all the responsible parties

However, the community spouse is not off the hook just yet. The law obligates them to support the other spouse. For instance, the state could make a claim against the community spouse in the future for medical expenses paid on the institutionalized spouse’s behalf.

Benefits of Spousal Refusal

  • The major benefit of Spousal Refusal is that the community spouse can protect their assets from the costs of the institutionalized spouse’s long term care.
  • If the state pursues the community spouse for the amount paid on the institutionalized spouse benefit at a lesser cost. As a result, the amount recovered by the state after the death of the institutionalized spouse is less than what they could have paid out of pocket for the same care.
  • Medicaid application may result in a quicker eligibility determination because only the assets of an institutionalized spouse are assessed rather than both spouses.
  • Spousal refusal can also work when the spouses are estranged or separated.
  • As per the federal law, a community spouse always has the right to seek a court order to help increase the spousal income or resource allowance

As mentioned earlier, spousal refuses only works when the situation occurs naturally. Meanwhile, it is not advisable to transfer all your assets to your healthy spouse and then applying spouse. Not all spouses stand to benefit from a spousal refusal situation.

It is not correct to view the spousal refusal as a loophole for asset preservation. You need to seek advice from a qualified consultant before transferring assets or acquiring Medicaid.

Getting Professional Help

At The Mattar Firm, we are dedicated to ensuring that we are here for the issues that matter the most to you in life. The Mattar Firm is dedicated to help you protect your family, wealth, future and personal legacy. We care for all our clients and look to put all our experience in creating lasting solutions for every situation. Call the Mattar Firm today if you are applying or know someone who is looking to apply for the Medicaid program. Our elder law attorneys are always at your service.

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