When your spouse needs nursing home care, you may worry that Medicaid will require you to spend the savings you need to remain financially secure. You may have heard that Medicaid considers a married couple’s finances when determining eligibility and wonder whether your spouse’s income or savings could prevent you from getting the care you need.
However, New York may allow you to qualify for Medicaid long-term care even when your spouse has income or resources above the ordinary limits through spousal refusal Medicaid in NY. If one spouse needs a nursing home level of care and the other does not, the spouse who does not need care can refuse to use their money or property to pay for the other’s care. The local social services district may later ask your spouse to contribute or bring a court action to recover Medicaid payments, so spousal refusal requires careful planning.
The Law Office of Andrew M. Lamkin, P.C., helps individuals and families throughout Long Island plan for Community Medicaid and Institutional or Nursing Home Medicaid. Andrew M. Lamkin personally handles each matter, listens to your family’s concerns, and explains how Medicaid planning can protect assets and support the spouse who remains at home.
How Do You Qualify for Medicaid Long-Term Care Coverage?
Medicaid can help pay for long-term care at home, in a nursing home, or assisted living facility.
Medicaid eligibility in New York requires that you:
- Need a nursing home level or care, meaning you need help to complete basic daily activities;
- Have limited resources; and
- Have a limited income.
To qualify, your countable resources must fall within limits set by law. Certain property does not count toward that limit, such as the home where you live and a personal vehicle.
How Does Medicaid Work for Married Couples When One Spouse Needs Long-Term Care?
Medicaid rules vary for married couples depending on whether one spouse needs qualifying long-term care or both spouses do. When you need qualifying long-term care and your spouse does not, Medicaid’s spousal-impoverishment rules protect a portion of the couple’s finances for your spouse.
Medicaid refers to the spouse who does not receive care as the “community spouse.” The spouse who does not need care may:
- Retain a protected share of the couple’s resources,
- Keep income paid in their own name, and
- Sometimes receive part of the other spouse’s income for living expenses.
If you are the spouse receiving care, Medicaid may require you to contribute part of your monthly income toward the cost of your care. Medicaid calculates the required contribution by subtracting certain permitted amounts from your income. Those deductions may include a personal-needs allowance for you and a community spouse monthly income allowance for your spouse.
How Resources Impact Calculation
In 2026, a community spouse can retain the greater of $74,820 or half of the couple’s combined countable resources, up to $162,660. If your spouse owns more than that amount, you may be ineligible for coverage.
How Income Factors In
Income affects the application differently from resources. Income paid solely to the community spouse generally does not count as income available to the applicant spouse. Therefore, a community spouse’s income ordinarily does not prevent the applicant spouse from qualifying for Medicaid.
However, a local social services district may, in some circumstances, request that the community spouse use part of their income to help pay for the applicant spouse’s care. The district generally requests 25% of the community spouse’s income above the applicable minimum monthly maintenance needs allowance, which is $4,066.50 in 2026. If the community spouse earns more than that amount, Medicaid requests that they contribute part of that amount to their spouse’s care.
The community spouse may refuse to pay without making an otherwise eligible applicant spouse ineligible for Medicaid via spousal refusal.
What Is Spousal Refusal for Medicaid?
Spousal refusal in New York allows a community spouse to decline to use their income or resources to pay for the applicant’s care. Spousal refusal prevents the applicant spouse from losing or being denied coverage merely because the community spouse will not provide the requested support. The district may respond only by seeking payment from the community spouse rather than withholding care from the applicant spouse.
After spousal refusal, Medicaid determines the applicant’s eligibility without treating the refusing spouse’s excess resources as money the applicant can use. Yet, the government may bring a court action to recover Medicaid payments made for the applicant spouse’s care from the community spouse’s resources. A court can order the spouse to pay, which the government can then collect against the community spouse.
Planning for Medicaid Eligibility with an Elder Law Attorney
An elder law attorney can help you and your spouse qualify for appropriate long-term care coverage while protecting money and property for both individuals’ needs.
Your attorney can help you:
- Identify countable resources and property that Medicaid allows you to retain;
- Calculate the applicant spouse’s financial limits and the community spouse’s protected allowances;
- Use permitted spending, transfers, trusts, or other strategies to address Medicaid’s financial requirements;
- Compare spousal refusal with other planning options and evaluate what the government might later seek from the community spouse;
- Prepare the Medicaid application and provide the financial records a local social services district needs; and
- Respond if the district disputes eligibility, requests a contribution, or brings a court action after spousal refusal.
Medicaid planning may also affect your will, trusts, powers of attorney, and beneficiary designations. An elder law attorney can coordinate those documents with the Medicaid strategy so that one part of your plan does not undermine another.
Through this process, you can determine how to obtain coverage for the spouse who needs care, what the community spouse can retain, and whether spousal refusal or another strategy offers the most suitable financial result.
Speak with a Long Island Medicaid Planning Attorney
The Law Office of Andrew M. Lamkin, P.C. is dedicated to supporting individuals and families throughout Long Island navigating Community Medicaid, Institutional or Nursing Home Medicaid, and related elder-law planning matters. As a member of the Elder Law and Trusts and Estates sections of the Nassau County Bar Association and NY State Bar Association, Andrew Lamkin is prepared to thoroughly assess your options, explain how New York’s laws apply to your family’ situation, and personally guide you through each stage of the process that follows. Contact the firm to discuss how spousal refusal for Medicaid in NY and other planning tools may help you secure care while protecting your family’s financial stability.
Andrew Lamkin is principal in the law firm of Andrew M. Lamkin, P.C., where he focuses his practice in the areas of elder law, estate planning and special needs planning, including Wills and Trusts, Medicaid planning, estate administration and residential real estate transactions. He is admitted to practice law in New York and New Jersey.