What Is Spousal Refusal?

Spousal refusal might sound like what happens when your partner doesn't want to take out the trash or visit your parents, but it's actually related to Medicaid coverage.

Understanding how spousal support works can be critical if one partner needs to go into a long-term care facility. Learn more about how this option works and how it could protect you financially.

What Is Spousal Refusal for Medicaid?

Spousal refusal allows a spouse to refuse to use their income or assets to cover the costs of long-term care for a Medicaid applicant. When someone needs to enter long-term care, such as in a nursing home or assisted living facility, they're expected to pay for the care. Spouses are also expected to take responsibility for those costs, even if they aren't in a care facility themselves.

Medicaid is a needs-based coverage option when your money runs out for long-term care. Normally, both spouses' incomes and assets are considered when determining eligibility. If you make too much money, it could disqualify your spouse from receiving care, and you'd have to put a large portion of your money toward the costs. With spousal refusal, only the income and assets of the person going into a care facility are considered. The state agency in charge of Medicaid can't deny care for the spouse who needs extra support when the other spouse refuses to pay.

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What States Have Spousal Refusal?

The option for spousal refusal was established on the federal level. However, states operate the Medicaid program, and there are only three states where spousal refusal is typically used. Florida and New York are two of the main states where the courts allow spousal refusal, since they've adopted the law in their area. A federal appeals court ruled in favor of a Connecticut spouse for spousal refusal in 2005, so it's the only other state where this strategy might work.

When Might You Use Spousal Refusal?

If you live in a state with spousal refusal, the most common situation for using it is when one spouse needs to move to a long-term care facility. Paying for that care will often drain their bank account, leaving the other spouse without enough money to survive. If you're able to use spousal refusal, you can get your spouse's Medicaid coverage to pay for their long-term care while preserving your income and assets to cover your expenses.