Medicaid’s Determination of Spousal Support

The calculated Medicaid spousal support when the husband or wife enters into a nursing home facility is often inadequate because Medicaid regulations base support on the poverty line for a family of two.  If a spouse is not pleased with the decision rendered by Medicaid on the issue of spousal support, then an appeal can be filed with the Office of Administrative Law.  A fair hearing will be conducted before an Administrative Law Judge.  The healthier spouse must prove that the spousal support awarded by Medicaid should be increased due to “exceptional circumstances resulting in financial duress.”

It is extremely difficult to prove exceptional circumstances resulting in financial duress.  Furthermore, even if an Administrative Law Judge rules that the support should be increased, that Judge’s decision is automatically reviewed by the Director of Medicaid, the Director of the Division of Medical Assistance and Health Services.  In many cases, the Director reverses a favorable decision rendered by an Administrative Law Judge.

A better option may be to file a family court action in the Superior Court of New Jersey.  According to a landmark decision rendered by the Appellate Division of the New Jersey Superior Court in the case of M.E.F. v. A.B.F., the healthier spouse does not have to prove exceptional circumstances or significant financial duress if a family court action is pursued in the Superior Court.

The Gloucester County Division of Social Services argued that the Superior court of New Jersey did not have jurisdiction to increase spousal support.  Furthermore, Gloucester County argued that the Superior Court could not increase support unless there existed exceptional circumstances and financial duress.  In the case of M.E.F. v. A.B.F., the Appellate Division ruled that a healthier spouse can obtain a court order from the family court awarding greater spousal support after Medicaid eligibility is determined.

Also, the Appellate Division ruled that a healthier spouse does not have to show exceptional circumstances and financial duress in an action filed in the family court.  Despite this favorable ruling, the Appellate Division did not allow an increase in spousal support.  The Appellate Division noted that the wife had embarked on the administrative path by receiving and challenging her spousal support.  The Appellate Division reasoned that the wife was limited to that path until a final administrative determination had been reached.

If you are not satisfied with the decision rendered by Medicaid on the issue of spousal support, then there are options available for you.  You can proceed with an appeal before an Administrative Law Judge or possibly file an action for support in the Gloucester County Superior Court.  It is important to review these rights with your qualified – elder law attorney so that your legal rights are protected for you.