Spousal Refusal

spousal refusal New York MedicaidA common misconception is that a community spouse must spend down all of his or her assets due to an institutionalized spouse requiring nursing home care before Medicaid benefits will be available. Medicaid is a means-test program that entitles individuals to benefits including Chronic Care Medicaid. Chronic Care Medicaid covers care that is provided in a skilled nursing facility. Because Medicaid is a need-based program, certain income and asset requirements must be met in order to be eligible for the benefits.

In New York State, a Medicaid applicant for Chronic Care Medicaid may have a maximum of $14,850 in assets and an income of no more than $50.00 per month. Any additional income must be used towards his or her cost of care. A person may also have retirement accounts, such as IRAs, so long as he or she is taking the minimum monthly distributions. A pre-paid burial account is considered an exempt asset. However, New York State provides exemptions to the eligibility requirements if a spouse still resides in the home and depends on the joint income to pay for expenses for their care and well-being. This individual is referred to as the “community spouse”, while the person requiring nursing home care is referred to as the “institutionalized spouse.”

The community spouse is a healthy spouse that can still maintain independence in his or her home. If an individual qualifies as a “community spouse,” he or she may retain a maximum monthly income of $3,022.50 and a maximum total of $120,900.00 in countable assets, in accordance with Federal Guidelines. In addition, his or her home is an excluded asset, so long as they are living in the property and the value does not exceed $560,000. This is known as a spousal allowance. However, in addition to a spousal allowance, New York Law allows a community spouse the option of signing a spousal refusal.

A spousal refusal is a legally executed document that must be filed in a timely manner along with the New York Medicaid application. This allows the Department of Social Services (DSS) to determine an applicant’s Medicaid eligibility for institutionalized care without considering the assets or income of the community spouse. In this instance, assets can be transferred to the community spouse without the five-year look-back period applying. A community spouse will then be able to have more assets and income in his or her name without affecting the institutionalized spouse’s eligibility. Typically, a spousal refusal is utilized where no pre-planning for future care has been prepared.

Planning for Medicaid eligibility can be done at any point throughout the process. However, in order to create the most comprehensive estate plan, pre-planning is the preferred method. If you are in the process of planning for the future needs of a loved one, an experienced New York estate planning lawyer can give you the legal guidance necessary to help plan for their future. From the simple to complex, the lawyers at Blodnick, Fazio & Associates are skilled in all aspects of estate planning and are dedicated to representing their clients with diligence and compassion. With an office conveniently located in Garden City, Nassau County, the firm is dedicated to providing high-quality legal representation at reasonable costs. Contact our Long Island estate planning lawyers at (516) 280-7105 to arrange a free consultation.

One thought on “Spousal Refusal”

  1. If the institutionalized spouse has transferred assets to the community spouse within 5 years of the application for Medicaid assistance, will DSS or some other agency require the transferred assets to be returned to the institutionalized spouse?

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