Spousal Refusal in New York Medicaid Planning

Spousal refusal is a New York strategy. The spouse who stays at home signs a written declaration that he or she will not make income and resources available to the spouse who needs Medicaid. Once that declaration is filed with the application, the local district evaluates the applicant on his or her own income and resources alone.

That matters because Medicaid otherwise treats a married couple’s finances as one pool. Without a refusal, the spouse at home keeps a set allowance and the rest of the savings is expected to go toward care first. For couples whose resources sit well above that allowance, a refusal can change the result entirely.

It is not consequence-free. The local department of social services may ask the refusing spouse to contribute toward the cost of care, and New York law gives the district a route to recover what it paid. Whether the strategy is worth using depends on the couple’s assets, the applicant’s likely length of care, and the family’s appetite for a claim later.

How Spousal Refusal Works

• The applicant spouse files a Medicaid application in the county where he or she lives.
• The spouse at home signs a declaration refusing to make income and resources available to the applicant, and it is filed with the application.
• The district determines eligibility using only the applicant’s own income and countable resources.
• If the applicant is otherwise eligible, coverage begins, and the district keeps a right to pursue the refusing spouse for support or reimbursement.

The legal footing comes from New York’s Social Services Law, which says medical assistance must still be furnished when a responsible relative has enough income and resources but those resources are not actually available to the applicant because of the relative’s absence, refusal, or failure to provide care and assistance. The same provision states that furnishing assistance in those circumstances creates an implied contract with that relative, and that the cost may be recovered.

Two points follow. The district cannot deny the application simply because the spouse at home has money. And its answer is not denial but recovery, which is why the decision is strategic rather than automatic.

The provision is written in terms of medical assistance generally, not nursing home care specifically. New York attorneys use spousal refusal both for institutional Medicaid, which pays for nursing home care, and for community Medicaid, which pays for home care. The refusal itself looks the same; what differs is the spending the district may later try to recoup.

A refusal does not make the couple’s finances private. Districts generally still ask for documentation of both spouses’ resources, and applications stall when it is missing. For the framework the refusal sits inside — resource limits, the look-back, home care rules, and estate recovery — see our page on Medicaid planning in New York.

The Trade-Off: The District May Come Back for the Money

A refusal does not extinguish the couple’s obligation; it moves the question to a later date. Having paid benefits, the district may seek contribution from the refusing spouse, and it may bring a proceeding to recover the cost of the care it provided.

How that risk plays out varies by county and by year. Some districts pursue these claims routinely, some only when the sums are large. Patterns shift with staffing and local policy, so a claim that seemed unlikely at filing may arrive two years later.

Before recommending a refusal, our attorneys weigh:

• The gap between the couple’s resources and what the spouse at home could otherwise keep. A small gap rarely justifies the exposure.
• The applicant’s expected duration of care. A short stay produces a smaller potential claim than years of coverage.
• Whether the care is institutional or community based, since the monthly cost differs substantially.
• The county’s recent posture on recovery, and whether a negotiated contribution is realistic.

A claim is also not the same as a judgment for the full amount. These matters are often resolved by negotiation. That is not a promise of outcome; no attorney can tell you in advance what a county will do.

When Spousal Refusal Makes Sense

Spousal refusal is worth considering when the couple’s countable resources exceed what the spouse at home may otherwise keep, or when the applicant’s income is needed to run the household.

Without a refusal, the spouse at home keeps a Community Spouse Resource Allowance, which New York sets annually. For 2026, the New York State Department of Health directed local districts to apply a minimum of $74,820 and a maximum of $162,660, with the actual figure depending on the couple’s combined countable resources. Resources above the applicable ceiling are expected to go toward care.

Income is handled separately through the Minimum Monthly Maintenance Needs Allowance, which sets a monthly floor for the spouse at home and allows some of the applicant’s income to be diverted to meet it. For 2026, New York’s figure is $4,066.50 a month. A spouse whose own income already exceeds that floor gets no diversion. Both figures change every January and vary with individual circumstances, so treat them as a starting point.

The pattern is straightforward. A couple with modest savings and a spouse living on Social Security usually does better inside the ordinary allowances. A couple with substantial non-retirement savings, or a spouse at home with a pension well above the monthly floor, is the classic candidate. A refusal also buys time when there is no five-year runway for a Medicaid Asset Protection Trust in New York, which is why it appears so often in crisis cases alongside gifting and promissory note planning.

Spousal Refusal and Your Own Estate Plan

A refusal that is not followed by estate planning can defeat itself. If the refusing spouse dies first and leaves everything outright to the Medicaid recipient, the assets land back in the recipient’s name. They become countable, eligibility is lost, and what remains at the recipient’s death may be exposed to estate recovery.

The fix is to rewrite the refusing spouse’s documents when the refusal is signed. That normally means updating wills so the survivor’s share passes to a trust for the recipient’s supplemental needs, or to children, rather than outright. Beneficiary designations on retirement accounts and life insurance need the same review, as do the deed to the marital home and any jointly held account with survivorship rights.

Where there are children from a prior marriage the redraft is more delicate, because the plan has to serve the recipient spouse and the children at once. Our page on estate planning for blended families covers the structures used for that.

If You Live in New Jersey or Connecticut

Spousal refusal is generally not accepted in New Jersey. New Jersey’s Medicaid regulation governing the resources of a married couple contains no provision allowing the community spouse to decline to make resources available, and no assignment or hardship mechanism of the kind New York provides, so our attorneys do not use it for New Jersey residents.

Connecticut is narrower than it once was. Connecticut law lets an applicant assign the right of support derived from the community spouse’s assets to the Commissioner of Social Services, but only where the applicant’s own assets are within the Medicaid limit and the applicant either cannot locate the community spouse or that spouse is unable to provide information about his or her own assets. A cooperative, locatable spouse who simply prefers not to pay does not meet that test. Connecticut law also lets the Commissioner seek recovery of assistance paid, up to the community spouse’s assets above the protected amount.

For couples in either state, planning shifts to tools that do not depend on a refusal:

• Resource allowance planning, which times the assessment and restructures ownership so the spouse at home keeps the largest allowance the rules allow.
• A Medicaid Asset Protection Trust, funded far enough ahead of an application to clear the look-back.
• Medicaid compliant annuities, to convert countable resources into an income stream for the spouse at home.
• Caregiver agreements that pay a family member for care under a written contract at a documented rate.
• Exempt transfers, spend-down on permitted items, and correct handling of retirement accounts, all covered on our general Medicaid planning page.

What Our Spousal Refusal Service Includes

We handle the refusal as part of a Medicaid case, not as a standalone form. That work generally includes:

• A financial review of both spouses, identifying countable and exempt resources and the income of each.
• A comparison of the likely result with and without a refusal, including an estimate of the district’s potential claim.
• Drafting the refusal declaration and the supporting documentation.
• Filing the Medicaid application, responding to district requests, and handling a fair hearing or appeal if coverage is denied or delayed.
• Rewriting the refusing spouse’s will, beneficiary designations, and powers of attorney, and reviewing title to the home and joint accounts.
• Representing the refusing spouse if the district later asserts a claim for support or reimbursement.

When Spousal Refusal Is Not the Right Tool

Spousal refusal is the wrong answer more often than families expect. It is generally not appropriate when:

• The couple’s resources are at or below the allowance the spouse at home could keep anyway. There is nothing to gain and a claim to invite.
• The spouse at home cannot tolerate uncertainty. A refusal leaves an open question for years, and some clients would rather spend down and be done.
• There is a five-year runway. Advance planning with a trust is usually cleaner and carries no recovery claim against the survivor.
• The refusing spouse’s assets are illiquid, such as a business interest or real estate that could be forced into a sale to satisfy a judgment.

Declining to use a refusal is a legitimate result, and we say so when that is where the numbers land.

Schedule a Medicaid Planning Consultation

If a spouse needs nursing home care or home care and your savings sit above the allowance, the decision about spousal refusal should be made before the application is filed. Our attorneys practice in New York, New Jersey, and Connecticut, and consultations are available in person, by video, or by phone.

This page is provided for general informational purposes only and does not constitute legal advice. Laws differ by state and change over time. For advice about your situation, consult a qualified attorney.