The Decision to Exercise Spousal Refusal Can Be Painful, But Often Necessary

Couples who are still married, even into their 70s or 80s are the lucky ones. They’ve made it through the hard times, the ups and downs of life, and still have their companion at their side. But even the most devoted of spouses is sometimes finds it necessary to exercise “Spousal Refusal” to pay the long-term care bills of their spouse when he or she has lost the ability to perform the activities of daily living. This may sound cruel and selfish, but as this article in the Huffington Post points out, exercising Spousal Refusal can sometimes be the only way to save the healthy spouse’s small nest egg for his or her own later years.

Spousal Refusal isn’t about turning away from a spouse in their time of need; in fact, many of the elderly individuals who exercise this option do so only after a long and painful decision-making process, and they do it not out of selfishness but out of necessity. “Those who need help beyond [the first 100 days of nursing or rehab care covered by Medicaid] are facing costs in excess of $100,000 per year in many areas of the U.S. It is not uncommon for someone to lose their house and all of their savings because they had to go into a nursing home.”

As the article points out, couples who choose to pay for a spouse’s long-term care costs won’t be left completely out in the cold. “Anti-spousal impoverishment laws were enacted on the federal level in the late 1980s. In 2012, the well spouse (or community spouse) is permitted to retain up to $113,640 in assets while his or her spouse is covered under the Medicaid program.” Unfortunately, in this day and age, $113,640 doesn’t go a long way, especially if the healthy spouse lives for another decade or so.

The decision to exercise Spousal Refusal is not an easy decision to make. Married couples must weigh the costs and benefits—not only financial costs and benefits, but emotional and ethical as well. No couple should have to go through this alone. The advice of a trusted elder attorney, or an estate or financial planner can help.

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