In the context of healthcare and elder law, “spousal refusal” occurs when a healthy spouse (in this case referred to as the “community spouse”) refuses to pay for the healthcare expenses incurred by their unwell spouse. Generally, married spouses are obliged to financially contribute to the healthcare costs of their spouses, including nursing home costs.
A spouse facing spousal refusal may fill out a form with Medicaid stating their spouse is refusing to contribute. Medicaid will then seek contribution or reimbursement from the “community spouse.”
In response to the often tight finances of the elderly, the federal government passed the Spousal Refusal law, which protects the community spouse from extraordinarily burdensome expenses, which may severely endanger the community spouse’s finances. In such cases, this law allows the ill spouse Medicaid access, and permits Medicaid to later seek reimbursement from the community spouse’s estate after his or her death. This methodology has generally been quite effective for couples facing significant healthcare costs in that it protects the couple’s assets, provides for the ill spouse, and gives reimbursement to Medicaid.
Currently pending in Florida’s House and Senate are two bills (HB 1323 and SB 1748) which would force the ill spouse to “cooperate” with Medicaid in seeking reimbursement from the refusing spouse. If the ill spouse is incapable of cooperating due to the nature of their illness, the ill spouse’s agent would be required to cooperate against the community spouse. Cooperation, although not yet defined, may include filing documents or testifying alongside Medicaid against the community spouse.
Certain amendments are being proposed by elder advocate associations such as the AARP and the Florida Department of Children and Families, which are attempting to move the focus off of mandated cooperation by striking sections and shifting the focus to targeting higher income individuals who are abusing the concept of Spousal Refusal. The purpose of the legislation should not be to make certain elders indigent, but rather to ensure that ineligible individuals cannot hide assets.
Without such amendments, the proposed legislation could have serious implications for elderly married couples. People who have been married for decades could begin considering divorce to separate property so that the ill spouse can continue to receive their much needed Medicaid, and the community spouse can pay family bills. Further, oftentimes when an elderly individual becomes too ill to oversee their affairs they appoint a child. If agents of ill individuals are legally forced to cooperate in seeking contribution from the community spouse, you will see houses divided and individuals compelled to speak against their parent or grandparent’s financial interest.
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