The last five governors in New York targeted a maneuver called “spousal refusal” for repeal 28 times. Newsday’s recent article entitled “State considers end to ‘spousal refusal’ to pay for nursing home care” says that there are some who think that this practice is a scheme to benefit the wealthy. However, an increasing number of advocates for middle-class elderly New Yorkers strongly support it as an essential way to keep a “well” spouse from poverty, when health care costs are skyrocketing.
Currently, New York and Florida are the only states that permit this practice.
However, now the state Medicaid Redesign Team is looking at if they should stop the decades-old practice. Governor Andrew M. Cuomo appointed the group of health care leaders to cut $2.5 billion from Medicaid, and their recommendations are due by mid-March.
Eligibility for Medicaid is based on family income and wealth, but there can be exemptions and special circumstances. A married couple who are both 65 years old or older can have no more than about $38,000 in annual income, and assets of no more than about $120,000, if one spouse is to be covered by Medicaid for nursing home care or comparable home care. As a result, any income and assets above those thresholds must be used to help pay for this care, which averages more than $10,000 a month in the Empire State.
This spousal refusal option lets the “well” spouse—the one who is not in need of care— to collect more income and retain more of the couple’s assets under his or her name. This process is replete with loopholes and is also complicated by federal law designed to protect more assets to avoid “spousal impoverishment.”
With a mandate to trim $2.5 billion from Medicaid in New York, it’s not clear how much spousal refusal costs the state. In 2016, the price was estimated at $10 million. However, this didn’t consider the continuing annual costs of each refusal, or the increased costs of care as the spouse who entered a nursing home gets older.
Spousal refusal has an increasing number of supporters for maintaining the practice, who say that it helps middle class families deal with soaring health care costs, prevents couples from having to spend their savings and give away assets to qualify for Medicaid and makes it unnecessary to contemplate divorce only to protect assets.
There’s one additional benefit: a spouse could enter a nursing home more quickly because Medicaid payments will kick in immediately and would avoid the lengthy process of determining eligibility.
Reference: Newsday (February 23, 2020) “State considers end to ‘spousal refusal’ to pay for nursing home care”