When one spouse needs nursing home care and the other is still living independently, New York families often fear they'll have to spend down a lifetime of savings before Medicaid will help. Spousal refusal is a legal strategy available in New York (and only a few other states) that can prevent exactly that outcome.
What spousal refusal means
Under New York law, the spouse who is not in the nursing home (often called the "community spouse") can sign a formal spousal refusal, stating in writing that they refuse to make their income and assets available toward the cost of their partner's care. When this refusal is filed correctly, Medicaid can approve the applying spouse's benefits based on that spouse's own resources, without requiring the community spouse to spend down their own savings, retirement accounts, or additional property first.
This is different from the standard Medicaid spousal impoverishment protections, which allow the community spouse to keep a Community Spouse Resource Allowance, currently up to $162,660 in New York for 2026 (a Department of Health figure that changes each year; see our New York Numbers page for the current amount), along with a minimum monthly income allowance. Spousal refusal goes further: it can allow the community spouse to retain assets above that allowance while their partner still receives coverage.
The state can still seek reimbursement
Spousal refusal doesn't make the community spouse's assets untouchable forever. After Medicaid approves benefits for the institutionalized spouse, the local Department of Social Services has the right to bring a support proceeding against the refusing spouse to seek reimbursement for the cost of care, up to the value of the assets they declined to contribute. In practice, many of these cases are resolved through negotiated settlements rather than paying the full cost of care, but this is a real legal exposure that needs to be weighed carefully, not treated as a loophole with no consequences.
When spousal refusal makes sense
- The community spouse has significant assets titled solely in their name that would otherwise need to be spent down.
- The couple did not have time to complete longer-term asset protection planning, such as an irrevocable trust, before a health crisis.
- The community spouse wants to preserve income or assets for their own future long-term care needs.
- The family is prepared for the possibility of a state reimbursement claim and wants to negotiate that outcome rather than lose eligibility altogether.
How it fits into a broader plan
Spousal refusal is rarely a stand-alone solution. It works best as part of a coordinated strategy that may also include asset retitling, careful income planning, and long-term protections like those described in our Medicaid asset protection trust guide. An elder law attorney can also help assess whether other tools, such as a properly drafted power of attorney, are in place so the community spouse can act decisively; see our power of attorney guide for more on that foundation.
Because spousal refusal involves both Medicaid eligibility rules and the risk of a support proceeding, it should be evaluated by an attorney familiar with your local Department of Social Services and its practices. Our Medicaid planning team regularly advises New York couples on whether this strategy fits their circumstances.
If your spouse needs nursing home care and you're worried about losing everything you've built together, don't wait to get advice. Schedule a free consultation or call +1 212 518 3868 to discuss your options with our team.
