Each January, the Governor of the State of New York puts out a proposed budget from which the Legislative and Executive branches will base their negotiations to determine a final budget. The budget is set to be passed by March 31; the date that marks the end of the fiscal year for the State. Just as in years before, our State Legislature is in the process of reviewing the proposed budget. There are several proposals in the budget that, if passed, will have an impact on the Medicaid program as we know it in New York State. Specifically, two in particular will affect married couples in need of care.
For the 27th year there is a proposal that “spousal refusal” be abolished in the home care Medicaid setting. Spousal refusal is the mechanism by which the spouse of a Medicaid applicant can maintain a Community Spouse Resource Allowance (“CSRA”) of assets above the Medicaid level as long as the spouse receiving Medicaid maintains assets below the permissible amount of $14,850.00. The removal of this provision from our program would not only apply to spouses but to other “legally responsible relatives” including the parents of children in need of the Medicaid program to help pay for the cost of care. The fear of losing the spousal refusal option is that this will force individuals to put a child or spouse in a nursing home in order to maintain enough assets to support themselves or force divorce or separation.
Compounding the issue of the loss of spousal refusal in the home care setting is the proposal to reduce the CSRA to $23,844.00. Currently, the law in New York states that a spouse can have up to $74,820.00 while the federal maximum is $119,220.00. Many fear that reducing the CSRA would make it difficult for couples to have a large enough emergency fund, putting them one leaky roof or flooded basement away from impoverishment.
Oftentimes, the spouse requiring Medicaid may live a long life beyond that of their sick spouse. The loss of these two important parts of our Medicaid program will force the healthy spouse to spend all of their money on the sick spouse and be left without assets to take care of his or her own needs.