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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.

Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

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If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

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Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.
For Medicaid purposes, whether two people are married governs whether: couple computation rules apply; spousal or parental deeming applies; and/or. spousal impoverishment rules apply.
The asset limit for a married applicant in most states is $3,000. Medicaid considers all assets of a married couple to be jointly owned. So, for a married couple with both spouses applying for Medicaid Long Term Care, all of their countable assets would be counted against their asset limit for both applicants.
See requirements by state. If the couple has assets greater than the allowable Medicaid limits, Spousal Refusal can protect additional assets for the community spouse. With Spousal Refusal, the community spouse's assets are not considered in calculating the asset eligibility of the applicant spouse.
Signing a spousal refusal. The community spouse signs a document indicating that they refuse to contribute to the care of the ill spouse since they will need all the income and assets for their own care.
Regardless of in whose name an asset is in, it is calculated towards the asset eligibility of the applicant spouse. Generally speaking, in 2025, the applicant asset limit for a senior is $2,000. Medicaid, however, allows a greater portion of the couple's assets to be protected for the non-applicant spouse.
The law does not make a distinction between separated spouses or those living together, therefore, a spouse that is separated but not divorced remains a "legally responsible relative" whose income and resources are considered when determining Medicaid eligibility.
Protected marital assets From that total, Medicaid subtracts an amount to be retained by the community spouse, plus a small amount (usually $2000) for use by the institutionalized spouse. Any remaining assets must then be depleted in order to qualify the institutionalized spouse for Medicaid long-term care services.