Medicaid in New York – Part II

Look Back Period for Institutionalized Medicaid

There is a currently a 60 month (5 year) look back period for obtaining institutional Medicaid benefits. This means that the Medicaid recipient has a five year look back period where he or she may be subject to being a self-payer.

Spousal Refusal

If the community spouse has assets greater than allowed in the year the benefits are applied for, these assets and/or income will be considered to be available to be utilized by the institutional spouse to cover healthcare expenses. New York will not deny institutional spouse benefits if the community spouse refuses to contribute. The community spouse can do this by signing a “spousal refusal” letter. When a community spouse refuses to make contributions to the other spouse’s care, the Medicaid recipient must execute an assignment of support rights regarding the community spouse to the benefit of the Department of Social Services.

Medicaid Can Sue in Spousal Refusal Situations

In spousal refusal situations, Medicaid has a right to bring a legal proceeding on behalf of the Medicaid recipient against the community spouse. They can take this action to force the community spouse to support the Medicaid recipient and/or to obtain reimbursement for the expenses they have paid on behalf of the institutionalized spouse. The best way to deal with Medicaid issues and spousal refusal issues is to retain an experienced elder law attorney to represent you on these proceedings.

estate planningElliot S. Schlissel, Esq. is a member of the National Academy of Elder Law Attorneys. He assists his clients with regard to Medicaid planning issues.