Spousal impoverishment in New York: keeping money when a spouse needs Medicaid home care

The state's 2026 notice says these rules may apply if one spouse is:

• In a hospital or nursing home and likely to stay at least 30 days in a row; or
• Getting home and community-based waiver services (federal 1915(c) waivers) likely for at least 30 days in a row; or
• Enrolled in a Managed Long Term Care plan,

and married to a spouse who is not in one of those groups. They do not apply to someone who qualifies under the MAGI rules (the rules for most people under 65 without Medicare).

Timing matters for home care. NY Health Access, a legal services guide, warns that the protections generally do not apply in the first budget when you apply for Medicaid to join an MLTC plan, and that you ask for spousal budgeting after MLTC enrollment. See the steps below.

The "spousal share" is half of the couple's combined countable resources at the start of the most recent continuous period of care.

1. Ask for a resource assessment. Either spouse can request one, even without applying for Medicaid. Use form DOH-5298 (Request for Assessment – Spousal Impoverishment) or contact your local Department of Social Services. In NYC, call the HRA Medicaid Helpline at 888-692-6116.
2. Know the fee. If the request is not filed with a Medicaid application, the local office may charge up to $25 for the assessment.
3. Apply for Medicaid for the spouse who needs care. Our HRA vs county guide explains where.
4. Enroll in the MLTC plan. See our MLTC enrollment steps.
5. Then ask for spousal impoverishment budgeting. In NYC, HRA's form MAP-751W has a box for "Spousal Impoverishment" and "Re-budget case." NY Health Access says to send it with the DOH-5298 after the MLTC enrollment. Outside NYC, send the DOH-5298 to your county.
6. Check the new budget notice. If the allowance looks wrong, you can ask for a fair hearing.

A community spouse can refuse to make their resources available. The state's notice says:

• Refusing to give information about resources is a reason to deny Medicaid, unless there is undue hardship and an assignment of support is signed (or the ill spouse is unable to sign one).
• If the community spouse refuses to make resources above the allowance available, Medicaid is not denied for that reason if the ill spouse signs an assignment of support to the local district.
• The state or county may go to court to recover Medicaid costs from the refusing spouse.
• Medicaid may ask the community spouse to contribute 25% of their income above the allowance. The community spouse can ask for a conference with the local office to discuss it.

NYC's spousal refusal form is HRA's MAP-2161 (per NY Health Access). Because a refusal can lead to a support claim, talk to a lawyer first.

• Statements for all accounts in either spouse's name, as of the start of care.
• Both spouses' income proof (Social Security letters, pensions).
• The deed or proof of the home, and car title.
• Housing costs (rent or mortgage, taxes, insurance) and utility bills. These can affect the income allowance.
• The MLTC enrollment letter, once you have it.

• Expecting spousal protections in the first Medicaid budget for MLTC. Ask again after enrollment.
• Spending down the community spouse's savings before getting an assessment.
• Filing a spousal refusal without understanding the support claim risk.
• Forgetting to ask for a family member allowance for a dependent living at home.