Spousal Refusal and Florida Medicaid: How the Assignment of Support Works

At application, federal law treats all countable assets of either spouse as available to the spouse needing care. That applies whatever state property law or a prenuptial agreement says. The protected spousal share comes out first (42 U.S.C. 1396r-5(c)(2)). DCF applies this even to couples who kept finances separate, and even when assets are covered by a prenuptial agreement (ESS 1640.0314.01 and .02).

Hypothetical: a husband needs nursing home care and has $9,000 in his name. His wife of eight years, in a second marriage, has $410,000 in her own IRA and brokerage account. Their combined countable assets are $419,000. After her $162,660 allowance, DCF would treat about $256,340 as available to him, far over $2,000. She considers that money hers, saved before the marriage for her own old age and her children.

The spousal impoverishment statute says the spouse in care isn't ineligible because of those attributed assets in three situations (42 U.S.C. 1396r-5(c)(3)):

the spouse in care has assigned to the State any rights to support from the at-home spouse; the spouse in care can't sign an assignment because of a physical or mental impairment, but the State has the right to bring a support proceeding anyway; denying eligibility would work an undue hardship.

Florida carries this out through the assignment form and DCF's undue hardship conditions.

DCF won't find the spouse in care ineligible because of the at-home spouse's assets if all four of these exist (ESS 1640.0314.04; Rule 65A-1.712(4)(g)):

The spouse in care isn't eligible because of the at-home spouse's assets, and the at-home spouse refuses to use them for the spouse in care. The Assignment of Rights to Support, CF-ES 2504, is signed. The spouse in care would be eligible if only the assets they can access were counted. The spouse in care has no other way to pay for long-term care.

Condition 3 is often misunderstood. Refusal doesn't shelter the spouse in care's own money. In the hypothetical, the husband's $9,000 still has to come down to $2,000 through ordinary spend-down. The other rules still apply too: the 60-month look-back, the income cap and a Miller trust if income is over $2,982.

CF-ES 2504 is short. The spouse in care, or a legal guardian, signs in front of a witness. Signing assigns to the State of Florida "any and all right, claim, title, and interest" to support owed by the named spouse. It also assigns the right to bring legal action to establish or enforce a support order. The assignment lasts while benefits are received and until the State is reimbursed, limited to the amount Florida paid (DCF form CF-ES 2504). Florida's rule says it may be signed by the spouse in care "or their representative" (Rule 65A-1.712(4)(g)).

DCF scans the form into the case file and notifies its Tallahassee headquarters on form CF-ES 2614. The manual is explicit that caseworkers don't suggest the form to a couple who would otherwise be ineligible. It's a response to a situation the family brings forward (ESS 1640.0314.03). Expect a caseworker to answer questions about the form, not to offer it.

A possible support action. The assignment hands the State the spouse in care's right to seek support. Florida law lets a spouse ask a court for support without a divorce (Fla. Stat. 61.09). The State could seek reimbursement from the at-home spouse, up to what Medicaid paid. DCF and AHCA don't publish how often they pursue these claims, so families shouldn't plan on "they never do." It doesn't erase the marriage. If the at-home spouse dies first, the spouse in care has a surviving spouse's rights, such as the elective share (Fla. Stat. 732.201). That can affect the at-home spouse's estate plan and Medicaid. Their will and beneficiary forms need a fresh look. Family strain. Adult children from a first marriage may read refusal as abandonment, even when both spouses agree to it. Scrutiny of transfers. Moving assets from the spouse in care to the at-home spouse is generally allowed, but late or large moves around the application will be reviewed. No guarantee. DCF must still find that all four conditions exist.

DCF describes the assignment as meant for "an existing situation." In practice, families tend to raise it in a few patterns:

later-life marriages where each spouse kept separate finances, often with a prenuptial agreement; spouses who have lived apart for years without divorcing; an at-home spouse who simply won't cooperate with the application.

If the at-home spouse has been separated for a long time and can't be found, DCF may treat the applicant as single. In that case refusal isn't needed (ESS 1640.0314.01).

Before refusal, families usually look at the ordinary tools:

Spending down on things of fair value. Asking at a fair hearing for a larger spousal allowance, when the standard one wouldn't generate enough income for the at-home spouse (ESS 1640.0314.01). Other lawful steps, depending on the facts.

Divorce is a separate decision with its own costs, and Florida Medicaid myths covers why it's rarely the answer.