Gov. Cuomo should not heartlessly force sick or elderly couples into poverty or unwanted divorce in order to get Medicaid long term care

03.13.2013, 12:09 AM

Apparently Gov. Cuomo has put the spousal refusal provision for Medicaid back on the list of possible cuts again in this year’s budget. The Staten Island Advance editorial says:

…The governor wants to eliminate the so-called “spousal refusal” provision that allows New Yorkers even at higher income levels to get Medicaid reimbursements for long-term care. The state Health Department says that doing so, would save taxpayers up to $100 million or more a year.

Spousal refusal allows the healthy spouse in a marriage to essentially divest the assets of a husband or wife in need of long-term care. In that way, the family need not spend the bulk of its own assets to pay for that care…

According to Republican Assemblywoman Nicole Malliotakis, who recently wrote a letter to the Advance opposing the governor’s plan, “Spousal refusal allows for a healthy spouse, known as the community spouse, to protect their entire life savings from being garnished by the government to supplement the massive expense related to assisted living and long-term care.”

She said that with it in place, the healthy spouse is allowed to keep the family home, a car and up to $113,640 in assets. Were the spousal refusal provision to be eliminated, the couple would have to live the rest of their lives with just $20,850 in assets.

As she notes, this would hit middle-class families particularly hard. Even younger families with children in which one spouse is stricken with a catastrophic illness would be wiped out.

Without the provision (which NY is fairly unique in having), couples have to spend down all their life savings or consider divorce in order to protect assets for the well spouse so they can get long term care through Medicaid for the ill spouse. (Keep in mind there is no long term care provision in Medicare, and private long term care insurance is prohibitively expensive for most.)

Here’s a piece I wrote at Huffington Post’s New York page one year ago, when he also tried this: “Gov. Cuomo Should Not Jettison the “Spousal Refusal” Allowance in State’s Medicaid Program“:

…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.

8 Responses to “Gov. Cuomo should not heartlessly force sick or elderly couples into poverty or unwanted divorce in order to get Medicaid long term care”

  1. Diane M says:

    I agree.

    I think the real solution has to be reforming Medicaid so that everyone is part of an insurance program that covers long-term health care. We just can’t afford to anything else as a nation.

  2. Jake says:

    Long-term care had to be stripped from the ACA because of Republican objections. NY State has its own version of long-term care insurance which, at the age of 65, costs about $3,000 a year. I intend to buy it when I become eligible for Medicare. I can’t afford it now on top of the $11,000 I currently pay for health insurance. The governor is right. Perhaps by forcing wealthy New Yorkers to pay their own way they might put pressure on the Republicans to do something about the scandal that is the cost of long-term care.

  3. Diane M says:

    @Jake – What about the people who don’t have $100,000 in savings, just own a home? Should they have to sell it before they can get health care?

    What if someone can’t afford $3,000 a year?

    And even what if someone could have afforded it but didn’t – are we really ready to tell them that now they have to sell their home and use up that money before they can get help paying for a nursing home?

    And don’t we want to encourage people to save?

  4. La Lubu says:

    Just off the top, my first impression is that the personal savings allotment is so high because of political compromise (but I could be wrong).

    I agree with Diane M.; if we don’t provide long-term care as part of the social safety net, the message that will be sent to people is: don’t bother to save, since if you get sick, you and your family will be wiped out anyway—we won’t help you keep what you’ve worked so hard for over the years. Instead, spend and enjoy now—because if all you have are happy memories instead of assets, we’ll help you right away….fewer hoops to jump through!

  5. Jake says:

    Diane M, I don’t know what you’re talking about. I don’t mean to be rude but perhaps we’re at cross purposes. I don’t think that anyone should have to pay $3,000 a year for long term health insurance. But that’s what it costs in NY state. And that’s about a fifth of what it costs on the open market. Long term care is the greatest transfer of wealth from the middle class to the insurance/health industry. They bankrupt us all. Unless we’re fortunate enough to die fast.

    The pretense of having nothing so the state can provide is so degrading I can’t believe that anyone would advocate it. Are we a first world state or not? Must we be ranked last in social services while we outspend all other nations for armaments by a multiple of 5 or 6?

  6. Diane M says:

    @Jake – Perhaps we are at cross purposes.

    I interpreted your statement that the governor is right to mean that you support getting rid of the spousal refusal provision. If you do that, it seems to me that it will hurt many people, not just the wealthy.

  7. Jake says:

    Diane. I do mean that. Good for him. Long-term care in NY state averages out at $80,000 a year.

    Let me make that clear.

    $80,000 a year. So if I get in the system and survive the bedsores and celebrate my fifth anniversary I owe 400, 000.

    Free market. Please help our governor to help us.

  8. Alana H. says:

    Hi there,

    Do you know when this is going to come into effect? At the same time, there should be some flexibility in this statute to cater to the different demographics. This is, if this program is supposed to really be something that people can count on when they’re faced with a long-term or terminal illness.