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Medicaid Planning: Spousal Refusal and Other Alternative Options, Asset Limits, Required Notice, Pitfalls to Avoid

Recording of a 90-minute CLE video webinar with Q&A

This program is included with the Strafford CLE Pass. Click for more information.
This program is included with the Strafford All-Access Pass. Click for more information.

Conducted on Thursday, August 4, 2022

Recorded event now available

or call 1-800-926-7926

This CLE course will provide an in-depth analysis of those states utilizing spousal refusal in Medicaid planning and other alternatives for Medicaid qualification. The panel will also highlight strategies for spousal refusal, determining when and how such a tactic impacts Medicaid qualification, and the processes and documentation involved, as well as offer methods to avoid common mistakes and pitfalls.


Having a sound Estate Plan in place is crucial for those seeking Medicaid asset protection for future care needs. A sudden illness requiring immediate long-term care placement or a degenerative diagnosis that will require extended care can devastate a family. Elder law attorneys may be able to utilize spousal refusal as part of Medicaid planning and other alternative methods to protect income and assets.

A Medicaid applicant's assets and income must meet certain state-mandated levels. Transfers of assets made within the 5 years prior to an application for nursing home Medicaid will be penalized if proper planning is not done. There are certain transfers that are exempt from penalty and certain Medicaid programs that do not impose a lookback, depending on the state of residence.

If the assets of the spouse of a Medicaid applicant exceed the asset and income levels, specific tactics can be used to gain eligibility for one spouse while protecting the assets of the other. Certain states provide for this option while others provide specific rules to prevent such tactics, which may lead to litigation. Elder law attorneys must understand the processes and requirements for utilizing spousal refusal to maintain Medicaid eligibility and other available options, such as promissory notes, loans, and other transactions.

Listen as our distinguished panel of attorneys experienced in Medicaid asset preservation reviews the eligibility requirements and discusses best practices in using spousal refusal, promissory notes, and other approaches to preserve the assets for Medicaid eligibility.



  1. Analyzing the spousal refusal strategy
  2. Spousal Refusal and Dissolution of Marriage
  3. Other options to maintain Medicaid eligibility
  4. Best practices for counsel, applicants, and community spouse


The panel will review these and other key issues:

  • What are the benefits and downsides of spousal refusal as a tactic for Medicaid eligibility?
  • What are the processes and requirements for using spousal refusal for Medicaid planning?
  • What are the state law challenges of utilizing spousal refusal?
  • What other options are available for Medicaid planning and long-term care?
  • How can qualified promissory notes be used with community spouses?
  • Using promissory notes and the impact of spousal refusal options


Burner, Britt
Britt Burner

Burner Prudenti Law

Ms. Burner, Esq. is a partner at Burner Law Group, P.C., a boutique law firm concentrating in the areas of Elder Law,...  |  Read More

Quarles, Patrick
Patrick D. Quarles

Richert Quarles

Mr. Quarles practices in estate planning, asset protection, probate, landlord tenant, pre-litigation, and civil...  |  Read More

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Strafford will process CLE credit for one person on each recording. All formats include course handouts.

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