Spousal Refusal: The Painful (But Sometimes Necessary) Decision

Couples who are still married, even into their 70s or 80s are the lucky ones. They’ve made it through the hard times, the ups and downs of life, ]and still have their companion at their side. But even the most devoted of spouses is sometimes finds it necessary to exercise “Spousal Refusal” to pay the long-term care bills of their spouse when he or she has lost the ability to perform the activities of daily living.

Spousal Refusal refers to one spouse’s official and legal refusal to pay for long-term care expenses of the other spouse. In general, married couples have a legal obligation to pay for the healthcare costs incurred by either spouse if they are admitted into a nursing home. However, if your spouse has been admitted to a nursing home, and you have limited resources, you may fill out a form with Medicaid stating that you refuse to pay for your spouse’s care. This may sound cruel or selfish, but exercising Spousal Refusal can sometimes be the only way to save the healthy spouse’s small nest egg for his or her own needs in later years.

Spousal Refusal is not about turning away from a spouse in their time of need; in fact, many of the elderly individuals who exercise this option do so only after a long and painful decision-making process, and they do it not out of selfishness but out of necessity. Patients who need more than the first 100 days of nursing or rehab care covered by Medicaid can find themselves facing costs in excess of $100,000 per year. It is not uncommon for a couple to lose their house and all of their savings because of one extended stay in a nursing home.

It is good to know that couples who forgo Spousal Refusal and choose to pay for a spouse’s long-term care costs after all won’t be left completely out in the cold. Anti-spousal impoverishment laws were enacted on the federal level in the late 1980s. In 2012, the healthy spouse is permitted to retain up to $113,640 in assets while his or her sick or recovering spouse is covered under Medicaid. Unfortunately, in this day and age, $113,640 doesn’t go a long way, especially if the healthy spouse lives for another decade or so. The decision to exercise Spousal Refusal is not an easy decision to make. Married couples must weigh the costs and benefits–not only financial costs and benefits, but emotional and ethical as well. The decision-making process can be emotional and overwhelming, and no couple should have to go through it alone. Contact our office if this is something you or your family is facing, we can help.

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