Medicaid is a federal program, run by individual states, that provides medical care to needy individuals. Many of our elders rely upon this program to access essential medical care for their long-term healthcare needs.

Accessing medical assistance through the Medicaid program is fairly simple at first glance. Generally, those with minimal resources will be afforded government assistance for their medical care needs. As the resources of the applicant increases, so too does the complexity of the application process. The program allows for the exclusion of certain assets and makes certain accommodations for the spouses of applicants, but there are many rules, details, and specifics that must be focused on for success.

The meaning of access to a financial account has recently been litigated in New Jersey. In a non-binding decision, the Superior Court of New Jersey disregarded the Medicaid applicant’s argument that she was physically and cognitively unable to access a joint account – ultimately leading to the inclusion of the resources against her for eligibility determination purposes.

Medicaid Basics

Medicaid is a program that makes medical care payments on behalf of the needy. When applying for long-term care benefits, neediness depends upon the applicant’s income and resources – the ability to contribute to the cost of their own care. Which resources are countable vary amongst states.

Establishing Medicaid eligibility requires a substantial amount of information from applicants. Understandably, the government only wants to offer benefits to those that truly need it. However, what if the applicant needs information from a spouse who refuses to give it? Spousal refusal means that a well spouse refuses to contribute his or her income or assets to the care of the institutionalized spouse. Spousal refusal is allowed in New York and Florida, where the states have enacted a version of the federal statute that authorizes it. In Connecticut, spousal refusal was upheld by a federal court in 2005. The New Jersey Division of Medical Assistance and Health Service has a spousal waiver, which is a waiver of the resource assessment in limited circumstances. Namely, there had to have been a break in marital ties before the institutionalized spouse sought Medicaid; or, there could have been an unverifiable death or divorce of the community spouse; or the community spouse’s whereabouts are unknown. In a recent case, the Superior Court of New Jersey considers an applicant’s spousal waiver in the absence of these pre-determined events.