Spousal Refusal and Asset Protection Planning for Medicaid Qualification

Admitting that one may need long-term and highly skilled medical care in a nursing home is not an easy concept to accept. For many, the thought is so unpleasant they fail to do anything to plan for this possibility, and then must scramble to qualify for Medicaid, which has strict income and asset limits. Waiting until the last possible minute to address Medicaid qualification issues limits the options a person has to protect his/her assets, and increases the chances the individual will be forced to use those assets to pay for care, and/or see the estate face reimbursement claims after his/her death if Medicaid benefits are paid. For those who are married, it is often easier to implement asset protection measures because of the spousal asset and income allowances, which are unavailable to single Medicaid applicants. In addition, the healthy spouse can also refuse to use his/her assets toward the costs of nursing home care for the other spouse, intending to reduce financial resources, so he/she can obtain government benefits. In other words, married couples have a few additional approaches to pursue when seeking to qualify for Medicaid, and the most appropriate route will depend upon the circumstances of each couple, particularly if a spouse needs benefits right away, and the type of assets the couple owns. An overview of the asset and income allowances the healthy spouse is permitted to retain, with a focus on the use of spousal refusal to facilitate Medicaid approval, will follow below.

Married Spouses’ Allowances

Medicaid’s Long-Term Managed Care Program, the plan used to structure nursing home benefits, is designed to cover only those individuals wholly without resources to pay for nursing home services. Thus, the income and asset limits that apply to both spouses and must be met at the time of application, even if one is not in need of institutionalized care. However, because the healthy spouse is permitted to retain countable assets up to $123,600, as of 2018 and not including the marital home, not all assets have to sold, transferred, or otherwise placed outside the control of the institutionalized spouse to qualify for Medicaid. In addition, while the institutionalized spouse is limited to $2,250 in income, the healthy spouse may be able to keep some of the other spouse’s income if it would otherwise to leave him/her in a poverty situation, though approval to keep it is required.

Spousal Refusal

Turning to spousal refusals, this measure allows the healthy source to disclaim all financial responsibility for the institutionalized spouse to facilitate Medicaid qualification, but certain rules must be followed for the government to discount the healthy spouse’s resources. Specifically, all assets must be transferred into the healthy spouse’s name, and he/she must execute a form that states he/she is refusing to pay for the other spouse’s nursing home care, and the institutionalized spouse must assign support benefits to the government, which effectively authorizes the government to sue the healthy spouse for reimbursement, though it has never been exercised at this point. By removing the healthy spouse’s income and assets from consideration, the spouse in need of care can usually qualify for Medicaid. However, the healthy spouse will not be allowed to both disclaim financial responsibility and take a portion of the institutionalized spouse’s income to supplement other sources. Depending on the situation, this approach may be the quickest way to Medicaid approval, but an elder law attorney should be consulted about all the options that could apply in each situation.

Talk to a Florida Medicaid Attorney

Medicaid is a complicated program that is hard even for those experienced with it to fully penetrate, and is quickly overwhelming for everyone else. Oldsmar medicaid lawyer William Rambaum has decades of experience helping Florida seniors access these benefits, and can help you organize your assets and estate plan to accommodate government eligibility rules. Contact the Oldsmar law firm to schedule an appointment today.

Resource:

ahca.myflorida.com/medicaid/Policy_and_Quality/Policy/behavioral_health_coverage/bhfu/Nursing_Facility.shtml