Spousal refusal in Florida is a Medicaid planning strategy that lets a married couple qualify the sick spouse for long-term care benefits even when the couple’s combined assets would normally disqualify them. The healthy spouse takes ownership of the countable assets, signs a written statement refusing to pay for the applicant’s care, and the applicant assigns their right to spousal support over to the state. The applicant then qualifies based on their own near-empty name, and the state gains a theoretical right to pursue the refusing spouse for reimbursement, something it rarely does in practice.
Florida is one of a small number of states where this approach is routinely used. It works because of a specific federal provision, 42 U.S.C. ยง 1396r-5(c)(3), that bars the state from denying the institutionalized spouse eligibility once the support assignment is in place.1Office of the Law Revision Counsel. 42 USC 1396r-5 – Treatment of Income and Resources for Certain Institutionalized Spouses The same statute also prevents any of the community spouse’s income from being treated as available to the applicant during a month the applicant is in a facility.
The Three Steps That Make It Work
The mechanics are straightforward and happen in order.
First, the couple moves countable assets into the community spouse’s name alone. Transfers between spouses are unlimited under Medicaid rules and do not trigger a look-back penalty, so the shift itself creates no eligibility problem.
Second, the community spouse signs a written refusal, often called a Notice of Spousal Refusal, declaring that they will not make their income or assets available for the applicant’s care. This is usually drafted as a notarized affidavit identifying both spouses, listing the assets being withheld, and stating the refusal in plain terms.
Third, the applicant signs an assignment of support rights. That assignment transfers the applicant’s legal right to pursue the healthy spouse for support over to the state, which is the condition the federal statute requires before the state can approve the application.
Once those three pieces exist, the state evaluates eligibility on the applicant’s own resources only. With the assets held by the community spouse and that spouse formally refusing to contribute, the applicant typically sits below Florida’s $2,000 countable-asset limit for individual Medicaid.
What the Community Spouse Would Otherwise Keep
To see why spousal refusal is attractive, compare it to the default rule. Federal law normally requires Florida to compute a Community Spouse Resource Allowance, or CSRA, when one spouse applies for long-term care Medicaid. The state takes a snapshot of all countable assets owned by either spouse on the date the applicant first enters a facility for at least 30 consecutive days, then divides that total in half.1Office of the Law Revision Counsel. 42 USC 1396r-5 – Treatment of Income and Resources for Certain Institutionalized Spouses
That half is then measured against federal floors and ceilings. In 2026, the minimum CSRA is $32,532 and the maximum is $162,660. A community spouse whose half falls below the minimum keeps the minimum. One whose half exceeds the maximum is capped there, and the overage has to be spent down on the applicant’s care before Medicaid starts paying.
Spousal refusal bypasses the entire calculation. Nothing gets spent down. The community spouse keeps the full pool of assets and simply declines to contribute.
Income, the Home, and Other Protections That Still Apply
Spousal refusal targets countable assets. Several other rules sit around it.
On the income side, Florida’s special income level for institutional Medicaid in 2026 is $2,982 per month. Applicants whose own income exceeds that figure can still qualify by routing the excess through a Qualified Income Trust, sometimes called a Miller Trust.
The community spouse has their own income floor, the Minimum Monthly Maintenance Needs Allowance. Effective July 1, 2026, that figure is $2,705 per month for all states except Alaska and Hawaii.2Medicaid.gov. 2026 SSI and Spousal Impoverishment Standards If the community spouse’s own income falls short of that floor, a portion of the institutionalized spouse’s income can be diverted to make up the difference before the balance goes toward care costs.
The primary residence is usually exempt. When the community spouse continues living in the home, it is fully exempt from the asset calculation regardless of value. Florida’s $752,000 home equity cap for 2026 applies to single applicants without a spouse in the home, so refusal cases generally keep the house protected. Other exempt items under Florida rules include one vehicle, personal belongings, prepaid funeral plans, and certain limited life insurance policies.
Filing the Refusal in Florida
There is no single mandatory statewide form for the refusal letter. The letter should identify both spouses by name, address, and Social Security number, list the specific assets being withheld, and state the refusal of financial support in clear language. Notarizing it as an affidavit is standard.
Alongside the letter, submit the applicant’s signed assignment of support rights and a full inventory of the community spouse’s assets: bank statements, brokerage accounts, real estate deeds, and vehicle titles. The state needs a clear picture of what is being withheld.
Submit through Florida’s ACCESS online portal or deliver the package to a local Department of Children and Families service center. For physical submissions, certified mail with a return receipt is the usual practice. Under federal rules, the state must process Medicaid applications within 45 days for applicants who do not claim a disability, and within 90 days for those who do.3Medicaid.gov. Ensuring Timely and Accurate Medicaid and CHIP Eligibility Determinations at Application Expect a case number and possibly a phone interview during that window.
The State’s Right to Come After the Refusing Spouse
The assignment of support rights is what makes the application work, and it is also what creates the exposure. Once the applicant signs it, the state steps into the applicant’s position and gains legal standing to bring a support proceeding against the community spouse to recover the costs of care it has paid.1Office of the Law Revision Counsel. 42 USC 1396r-5 – Treatment of Income and Resources for Certain Institutionalized Spouses
Florida law backs this up. Under Florida Statute 61.09, a person with the ability to contribute to the maintenance of their spouse who fails to do so can be sued for support without the need for a divorce proceeding.4Florida Statutes. Florida Code 61.09 – Alimony and Child Support Unconnected With Dissolution Florida Statute 409.2561 addresses support obligations and assignment of rights when public assistance is being paid.5Florida Statutes. Florida Code 409.2561 – Support Obligations When Public Assistance Is Paid; Assignment of Rights; Subrogation
The practical reality is that Florida rarely sues a refusing spouse. The legal authority sits on paper, and the community spouse may receive a demand letter requesting reimbursement, but civil litigation against elderly spouses is expensive and politically unappealing for state agencies. Rarely is not never, and future budget pressures or policy shifts could change the pattern. The community spouse should treat the possibility as a genuine contingent liability.
The dollar figures involved are not small. Nursing home costs in Florida commonly run between $9,000 and $14,000 per month depending on region and room type, so the potential recovery amount accumulates quickly. A judgment for accrued care costs could materially affect the community spouse’s finances.
Estate Recovery After the Medicaid Spouse Dies
Florida also runs a Medicaid estate recovery program under Florida Statute 409.9101, which allows the state to file a claim against the estate of a deceased Medicaid recipient to recoup benefits paid. The statute carves out important protections: the state cannot pursue estate recovery if the recipient is survived by a spouse, a child under 21, or a child who is blind or permanently disabled.6Florida Statutes. Florida Code 409.9101 – Medicaid Estate Recovery
As long as the community spouse outlives the Medicaid recipient, estate recovery is off the table. An undue hardship waiver may be available in narrow circumstances, such as an heir residing in the decedent’s home with no other residence, or recovery that would deprive an heir of food, shelter, or necessary medical care. A reduced inheritance alone does not qualify as hardship.
If the Application Is Denied
Both the applicant and the community spouse have the right to request an administrative fair hearing if the Department of Children and Families denies the application or takes other adverse action.7Florida Department of Children and Families. Appeal Hearings The request must be filed within 90 days of the Notice of Case Action.
A hearing is also the venue to challenge the state’s resource assessment at the snapshot date. The state must provide each spouse with a copy of the assessment and notice of the hearing right.1Office of the Law Revision Counsel. 42 USC 1396r-5 – Treatment of Income and Resources for Certain Institutionalized Spouses A community spouse who can show that the standard CSRA will not generate enough income to meet actual living expenses may be granted an increased allowance above the normal maximum.