Has anyone had any experience in writing a spousal refusal letter to Medicaid?

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Friday4 Asked March 2022

Has anyone had any experience in writing a spousal refusal letter to Medicaid?

My husband is in Stage 6 Alzheimer's. I've recently seen an elder care attorney who suggested that this may be my best option. This is a Federal Medicaid law that allows the community spouse to keep all of her (or his) assets by simply refusing to support the institutionalized spouse.

This is second marriage for both of us, we have always kept our assets separate. We both have our own houses. Medicaid (MA) would count my retirement that would exclude him from getting Medicaid unless I spend it down to a certain amount. This is huge for me because I've been taking my Required Minimum Distribution for 2 years & I use it for my real estate taxes, house insurance etc.

Thank you....this forum is great, a lot of good information.

Asset Protection Medicaid Spouse

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score 6 · Answer 1

You are doing the right thing to have an elder care attorney. This is complicated and the legal aspects have to be set up correctly.

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score 6 · Answer 2

The best advice is just to listen to your lawyer. It’s hard to go by what others have done or say since each state is different and the lawyer knows best how to handle things in your particular case. Good luck.

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score 5 · Answer 3

Federal law? I believe only NY and Florida follow this doctrine.

Why isn't your lawyer giving you guidance?

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I did research this & found that it can be used throughout the country. It has been challenged, but, in most cases, it has been allowed (Conn. & MA). I am seeing a lawyer, but, was curious if anyone has done this.

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score 5 · Answer 4

My father-in-law used this strategy in Texas. His wife with end stage Parkinson’s was accepted in skilled nursing. BUT the letter was crafted by lawyer well versed in Medicaid. His major retirement savings was an inherited investment account and easily separated by Texas and federal law for his use only. I won’t go into other steps because lawyer crafts each case specific to state Medicaid law. You are still subject to Medicaid renewals and if spouse wants a voice in care and placement you will need assistance with renewals and any requests for community spouse resource allowance to make sure you don’t cause Medicaid issues as you are still married.

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score 4 · Answer 5

I would have thought the lawyer would have drafted it for you to be sure it is adequate in the state where you live. It is my impression, in our state there are already provisions in place for a “community spouse” not to have to give up or split everything half and half… automatic and not even a choice to be made. The intent is that one spouse in a facility should not make the other destitute as a result. If the letter from the attorney was not included in his services, it may be well worth it to pay the extra charge to be sure it is done correctly.

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score 3 · Answer 6

This is a good question, which makes me wonder: does the spouse have to be institutionalized for you to “refuse support?” Can the spouse still be at home and you refuse support?

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score 2 · Answer 7

This link https://www.medicaidplanningassistance.org/spousal-refusal/ is to an article that provides enough information for you to craft a spousal refusal letter. If you can afford it, by all means have your attorney craft and send the letter. (Nothing like a legal firm's letterhead to get their attention!).

If you cannot afford the attorney, as a former technical writer I recommend your letter be concise and to the point. State your purpose in the first line of the first paragraph. (This letter is to formally present my refusal to.....). Don't provide I formation that is not specifically required. Good luck.

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score 1 · Answer 8

@Friday4 speak with the lawyer they should answer all your questions, but yes this is a means that many use to avoid Medicaid issues like getting approved to even avoid them going after assets even in death. Just requires a well versed lawyer.

As a good lawyer told me the intent or purpose of the law is irrelevant all that matters is how it is a written, and in truth many loopholes are present that do allow families to keep everything and not spend a single dime on care. Just need to find an experienced lawyer.

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score 1 · Answer 9

Friday4: Imho, the attorney that you saw should be providing this information to you.

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score 0 · Answer 10

I was under the impression that marital assets can be split. That SS belongs to the person who earned it. So, when Assets are split the Community spouse gets the SS they earned and its determined how much of the other spouses SS and maybe pension the Community Spouse gets to live on. It has been mentioned here that a Community Spouse got the whole monthly income because it was needed for them to live.

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Has anyone had any experience in writing a spousal refusal letter to Medicaid?

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