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She is also elderly, still works, and refuses to pay for care for him (luckily he doesn't need much now). Their finances are separate (bank accounts, retirement, etc.), but I'm finding that he isn't eligible for government programs because of her income (his is low and hers is high). What are the options?

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Check to see if your state has a law called "The Doctrine of Necessities". This law was meant to prevent husband's from not caring for their ailing spouses back when women didn't work. Many states still have this law and if they do, the spouse is just as responsible for paying for the cost of medical care, as long as the care is medically necessary.
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Yes, I'm raising an eyebrow at one spouse "refusing" to pay for another's care needs. What would we be thinking if it were a husband doing that to a wife? Grounds for divorce on its own, surely.

But I agree with PStegman: if your father's needs aren't currently a problem - i.e. you're not yet concerned that his welfare is at risk - you should leave them to sort this out on their own. You've no cause to meddle.

How elderly is "elderly", by the way?
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I agree with Igloo about the co-mingling of funds. Unless she has inherited money which was never co-mingled with their funds, she just can't walk away. If she used her money in any way to the betterment of the marriage it becomes co-mingled. And my daughter, who is a corporate attorney in Boston, told me so many, many times pre-nups are often done incorrectly and don't hold up in court. People try to hide things or are just ignorant of what they should declare.

But we all would love to hear more about the step mother and her reasons for not wishing to support her husband. I do understand her frustration about working her entire life and having nursing care take so very much. But this could be her and she could be needing nursing care. What would she say if the shoe were on the other foot?
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If he has no needs right now, don't stir up a hornets' nest. He should be eligible for Medicare and he can buy a supplemental policy that will cover almost everything. It even covers PT,OT and VNA if the MD orders it. Try to stay out of it as long as you can. They are both adults.
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It is ten years of marriage in order to qualify for your spouse's SS benefit.

At this point, if they divorce it will be looked at as Medicaid avoidance and he will likely be declined. It can get appealed but you will need an attorney to deal with the appeal as they are sticky. So pay for an experienced attorney now or pay later, but you & Dad really need to speak with someone legal before this goes on too far. i would go with Dad without his bride to get a feel on what the options are. If you are in a community property state, then she is SOL in keeping funds from him for whatever they have acquired since their marriage. If she co-mingled her $ from before they married, those are toast on her keeping them too. Property in her name which she has kept in her name with no joint use, she may be able to keep but if any of this was presented as their's, she is toast on keeping it from him. A good pit bull of a divorce attorney may be consulted with by your elder law attorney to make this happen. None of this is going to be pretty but with NH costing between 5K - 15K a month, you have to go hard-ball on all this, unless you have the ability both financial & caregiving time to take him in & do for him forever.

About the spousal impoverishment, what could happen is that if she does that and dad is unable to do for himself, he could be declared a "ward of the state" and then the state appoints a guardian for him who manages all for him and his finances. the state would pay for his care and would seek reimbursement from any possible assets he or his spouse has (not you assets). Here is where it could get ugly…..since he is a "ward" neither you or the wife need to be contacted regarding his care, or where he lives, etc. The guardian can have him move to a NH in another county which is desperate to fill their beds. This would be just awful, really you don't want this to happen. And then as this winds through the system, the state could try to place a lein against any assets that are community property or have been presented as a joint asset as spouse refusal is hard to do.

Now what is her issue? Is she mentally sound? is this new & totally not-like-her type of behavior? Could there be something wrong with her….like she has dementia or other illness that is causing paranoia. Or is she just basically a cold hearted witch? It's odd behavior, especially for a female. What was the situation for her prior marriage and her relationships with her kids? Could any of this be coming from her kids???
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My understanding about Social Security is they have to be married ten years for them to benefit under the others. And they do not collect both, rather whichever is higher, I think. But, again, you need to check with an attorney, Social Security would be able to answer that question.
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These are good comments and I agree with those who suggest you seek the advice of an attorney.

That said, I feel very sorry for your father. How can this make him feel? Is he aware of his wife not willing to help him in his old age? Did he do something to make her become so miserly with her money? I understand her hard work and wanting to maintain her finances. But when we marry, we are supposed to love each other in sickness and health. I would be very in touch with his feelings about all of this. I come from a family of misers and my husband is a bit miserly. Sometimes it makes me feel very sad and depressed. Take care of your father's emotional needs as well.
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"Divorce" was the first thing I thought of when I read your post. I see that it's already been suggested. They wouldn't be the first couple to divorce for this reason.
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Ten years ago divorce was an option in this situation. I don't know what the situation is now. Clearly this whole case needs the help of an attorney.
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But if they divorce, won' t they be giving up each other's Social Security (when the other passes).
And if they do divorce, but continue to maintain same residence, I think Medicaid will consider them a household despite the divorce. and Medicaid always looks "back" regarding finances, so I suspect the "divorce" would be called into question.
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An elderly friend of mine was advised by her daughter and son in law, both attorneys to divorce. This will help her as she will not be responsible for him and hopefully he can file for assistance. Do they file joint tax returns? Honestly if you are going for Medicaid, they may not buy the divorce at this late date. There are attorneys that work with Medicaid and laws to help you. See if you can find one.
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No prenup and they've been married for several years.
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Unfortunately, as far as Medicaid is concerned, her money is his money and vice versa.

One option is for him to rely on his income only and try to self-pay for all of his care. That may not be realistic or possible.

Is he a veteran? If so, help him look into what help he might be eligible for.

Another option is divorce. They could, of course, continue to live together, but not have the legal status that is a disadvantage to your father. I would certainly not pursue this without competent legal advice.

In fact, getting advice from an attorney specializing in Elder Law would be a good idea at this point.
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Since you are referring to her as his wife she must not be your mother. When were they married? Do they have a prenuptial agreement? If so, she most likely is not responsible for his needs. But when it is necessary for Medicaid they do not care if there is an agreement in place. Before either is eligible both have to have income that is below their threshold. The only answer to get your dad under Medicaid that I know of is through divorce. Another possibility is called spousal impoverishment, don't know anything about that but an elder law attorney would be able to assist with that. Check the website AVVO to pose your question to attorneys at no cost, and receive several replies. The site also has peer and client ratings.
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