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Gov. Cuomo Should Not Jettison the "Spousal Refusal" Allowance in State's Medicaid Program

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Getting rid of the "spousal refusal" allowance will heartlessly force elderly New Yorkers to consider divorce in order to qualify their sick spouses for the care they need.

Gov. Cuomo is not alone in wanting to reign in costs for Medicaid, the health program for low-income persons that costs states big money. But his proposal to eliminate the "spousal refusal" allowance in his next budget is a bad idea, one that will heartlessly encourage divorce among New York's most vulnerable elderly.

The "spousal refusal" allowance has been that rare and wonderful example of a state policy that works well. Unlike most states, New York's policy allows the assets of a healthier spouse to be protected if an ill spouse needs to qualify for long-term care through Medicaid.

Most people do not realize that long-term care is not paid for by Medicare or by most private insurance plans. Instead, in most states when a spouse becomes elderly or disabled and needs long-term care, and if the couple has not previously bought expensive long-term care insurance, the couple's only options are to pay out of pocket for long-term care or to "spend down" their family assets to qualify for Medicaid. Spending down means that the healthier spouse loses practically all assets in order to get needed care for an ill spouse, in the meantime losing their current standard of living and leaving the question of how to pay for their own future needs terrifyingly unknown.

Anecdotal evidence suggests that some well spouses must consider the heart-wrenching decision to divorce the person they love in order to obtain the medical care their loved one needs. As director of a New York-based Center on Marriage and Families, I am seeing signs of this trend, one that will likely grow as the massive baby boom generation ages.

A pastor in Indiana wrote to me: "Yesterday I received a call from an elderly woman who is seeing her government funding for medicine decline to where she and her husband cannot afford to buy medicine. They were told by those they sought help from -- government officials -- it would be better if they divorced and then just lived together. She openly cried to me that she didn't want to divorce, she didn't want to break her sacred marriage vows, but that she had no choice, and was told it was the only way to get help."

Recently a Mormon blogger in Utah wrote of her married friends Joanne and Gerald, the latter of whom has dementia. She writes, "Gerald really needs to be in a long-term care center, but nursing home costs are prohibitive for families who failed to purchase long-term care insurance when they were young and healthy. Medicare pays for only 90 days of nursing home care. Medicaid eligibility occurs only after a couple has exhausted their own resources... It looks like Joanne's only options are: a) to continue caregiving at home until she exhausts herself and possibly dies first, b) to impoverish herself by paying for Gerald's residence in a care center until their savings are exhausted, or c) to divorce him and let him go on Medicaid." The blogger concludes, "These are scary old-age prospects for couples."

Experts agree. The former president of the National Academy of Elder Law Attorneys, Bernard A. Krooks, told the Norwood News that the proposed change would be "devastating for people. It would force people to get divorced in order to pay for health care."

Critics charge that New York's spousal refusal allowance benefits wealthy New Yorkers who get to protect their assets while using Medicaid to care for their sick spouse. But let's face it: people with resources want to pay for the best quality, most attractive and most home-like long-term care settings, which often don't accept Medicaid. Those who will really suffer under the governor's proposed change are elderly middle and low-income New Yorkers, people who worked hard all the years they were healthy and should not callously be forced into divorce by the state in order to get the health care they need.