Medicaid Claims Against A Community Spouse

Medicaid Claims Against a Community Spouse

Medicaid payments for elderly and disabled New Yorkers in 2022 are expected to approach $75 billion, of which New York State will pay approximately $24.5 billion. Government regulations require states to seek reimbursement from the estates of Medicaid recipients, and states may also press legal claims against one spouse to regain the money spent by Medicaid to pay for the institutional care of the other spouse.

If  you and your spouse’s income or the value of your countable assets is higher than the maximum allowed to qualify for Medicaid benefits, then you need to speak with an experienced elder law attorney immediately.

Ely J. Rosenzveig & Associates will work to help protect your income and other assets while preserving your eligibility for Medicaid benefits, like long-term nursing home care, or other institutional care needs. The need for one spouse to reside in a nursing home should not require their life partner to sacrifice all of their hard-earned assets or to spend down funds they intended to pass to their children and grandchildren.

Couple and Community Spouse Income and Asset Limits in 2022

In New York, when your spouse is admitted to a nursing home or long-term care facility, Medicaid will pay the cost of their care if you meet the following financial profile:

  • Monthly Income for Applicant Spouse in Nursing Home – $50
  • Resource Allowance for Spouse in Nursing Home – $16,800
  • Monthly Income Allowance for Non-Applicant Community Spouse – $3,435
  • Maximum Federal Resource Allowance for Community Spouse – $137,400
  • Minimum State Resource Allowance for Community Spouse – $74,820
  • Medicaid Home Equity Limit – $955,000

If both spouses are living in the community with Medicaid paid homecare or other services, then the couple’s Medicaid eligibility income and resource limits are more restricted:

  • Monthly Income Allowance for a Couple Both on Medicaid – $1,367
  • Resource Allowance for a Couple with Both Spouses on Medicaid – $24,600

Spousal Refusal to Contributing Money: “Just Say No”

Medicaid Claims Against A Community Spouse
Spousal Refusal is just what it sounds like. Sometimes called “just say no,” this tactic forces Medicaid income and asset accountants to focus only on the institutional spouse’s income and assets.

While some commonly owned assets, like your primary residence (up to the $955,000 threshold), and a single automobile, are not counted, Medicaid does count other financial resources that exceed the value for program eligibility. Vacation homes and investment property count; stocks and bonds count, as does any income exceeding the monthly limit.

When income or resource limits are exceeded, Medicaid regulations compel a community spouse with available income or resources to contribute to the expense of providing long-term nursing home care to their spouse. In New York, a non-applicant, community spouse can “Spend Down” the excess income or assets to reduce them to the Medicaid allowance level, or they can file a “Spousal Refusal.”

Spending Down means reducing the amount of your income or resources over the Medicaid limit until you reach the program’s eligibility level. One strategy is to transform the excess countable income or assets into an exempt asset. For example, remodeling a primary residence bathroom to be disabled-accessible, or adding a wheelchair ramp, or trading in a car for an expensive wheelchair accessible van, are all acceptable spend-downs for Medicaid.

Spousal Refusal is just what it sounds like. Sometimes called “just say no,” this tactic forces Medicaid income and asset accountants to focus only on the institutional spouse’s income and assets. If the figures are beneath the allowable limits, Medicaid will pay all nursing home and other healthcare related expenses for the spouse in need. But the law permits the State of New York to file a lawsuit against the community spouse demanding reimbursement of the nursing home cost. It also directs the state to seek reimbursement from any Medicaid recipient’s estate after their death.

What Happens When Medicaid Demands Reimbursement?

Legal actions against community spouses seeking reimbursement for the care of the other spouse were infrequent years ago. Now, state budget pressures have substantially increased the likelihood that  community spouses will face Medicaid recovery claims. Ely J. Rosenzveig & Associates has an impressive track record of defeating or minimizing these claims.

The initial demand for one spouse to contribute to the other spouse’s care comes in the form of a notice from Medicaid. Since Medicaid pays a reduced price for nursing home services, the agency seeks repayment of their lower cost. You might think paying the lower rate is better than paying the market rate. But, Ely J. Rosenzveig & Associates has shown that there may well be the opportunity to negotiate a settlement with Medicaid that reduces the reimbursement sum further, saving thousands of dollars in the process.

Ely J. Rosenzveig and Associates has extensive experience negotiating much lower settlements for community spouses, often reducing their ultimate contribution to a fraction of Medicaid’s original demand. Contact the elder law attorneys with a history of positive results fighting Medicaid claims against community spouses.

Snapshot of Income and Assets

When Medicaid analyzes an applicant’s assets to determine eligibility, it considers only the income and assets the couple owns or can control on the date of their application for benefits. That single day’s view is referred to as the “snapshot” of their financial resources. To distinguish precisely what can and cannot be included in Medicaid’s count, you should consult with an experienced elder law and Medicaid lawyer.

How Can an Elder Law / Medicaid Lawyer Help Save Your Assets? — A skilled elder law attorney with Medicaid experience examines each of your assets to determine the extent of your ownership. For example, if your in-laws deeded their home to you and your spouse but reserved a life estate for themselves, then the property is not yours to dispose of until the last surviving in-law passes away. At the time of your spouse’s Medicaid application, the property is not a countable asset.

This asset analysis often reveals that resources attributed to a community spouse’s ownership were mistakenly considered as assets. If Medicaid learns that property it believed was an available asset to reimburse the funds spent for a spouse’s nursing home care was not an owned and available asset on the “snapshot” date, then Medicaid’s claim against a community spouse may be abandoned.

Preplan with a Sound Estate Plan to Preserve Medicaid Eligibility

The experienced elder law attorneys at Ely J. Rosenzveig and Associates provide invaluable assistance to spouses facing Medicaid demands for the reimbursement or spend-down of hard-earned financial assets. And, planning ahead can prevent the situation entirely. With a professionally drafted estate plan, the law permits your assets to be completely protected. Transferring assets into a trust that you create with your elder law attorney is one option.

Call Ely J. Rosenzveig and Associates today for help with Medicaid Reimbursement Claims, or to help design for you and your family an estate and asset protection plan that will help preserve your financial assets, and have you or a loved one qualify for robust Medicaid benefits.

Call Ely Rosenzveig and Associates at 1.914.816.2900
or email us at: [email protected]

Ariel S. Rosenzveig
Ariel Rosenzveig

Ariel S. Rosenzveig received his Juris Doctor from the Benjamin N. Cardozo School of Law in May, 2011, and has been practicing law with the firm since August, 2011. During his summers while in law school, Ariel interned with the United States Commodity Futures Trading Commission in New York and with the Securities & Futures Commission in Hong Kong, China.

While in law school, Ariel served on the staff of the Cardozo Public Law, Policy & Ethics Journal, volunteered with the Cardozo Advocates for Battered Women, and participated in the National Institute for Trial Advocacy’s Intensive Trial Advocacy Program. Prior to attending law school, Ariel worked as an arbitrage trader for a small proprietary trading firm on Wall Street. Ariel graduated summa cum laude from Yeshiva University in 2006.

Ariel is licensed to practice law in the states of New York and New Jersey, and is a member of the New York State Bar Association (NYSBA), NYSBA’s Elder Law section, and the National Academy of Elder Law Attorneys (NAELA). In June, 2015, Ariel successfully completed a certificate program in mediation through the Program on Negotiation at Harvard Law School.

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