Flaws in U.S. Health Care System Pushing Couples Into Divorce

When a Methodist minister divorced his wife of 32 years in a Nebraska courtroom last month, it was not because of the usual string of irreconcilable differences.

Rather, the Rev. Lincoln B. Justice, 60, and his paralyzed wife, Rose Marie, 56, of Lincoln, dissolved their marriage to circumvent rules in the nation’s health-care system, which, the couple says, forces its citizens into poverty before it will provide basic health care.

Now, as a divorced woman, Rose Marie Justice will be able to stay in her home and deplete her savings until she qualifies for Medicaid and the full-time nursing help she needs since a 1979 auto accident left her a paraplegic.

If she had stayed married, new provisions added to the expanded Medicare program, designed to prevent spousal impoverishment, would not have helped her.

These changes, introduced by Sen. Barbara Mikulski (D-Md.) allow the healthy spouse to keep half the couple’s assets if the other is admitted to a professionally staffed nursing home. But if the ailing spouse chooses to remain at home, the benefits only cover part-time nursing for 38 consecutive days.

Wrenching Decision

The Justices made the wrenching decision after the minister, in order to pay for full-time care, took a new assignment requiring him to live 30 miles away, in the Weeping Water parsonage. That home is not wheelchair accessible.

“And since we’ve already decimated our lifetime savings to make our home in Lincoln barrier-free and hired a homemaker,” said Rose Marie Justice, “it just made no sense for me to leave it.”

In an emotional dissolution ceremony in his church in Lincoln, the minister vowed to “remarry my wife should the nation’s laws ever change to allow us to live” in something other than poverty.

His wife added: “We’re not senior citizens yet, so we don’t qualify for Medicare. And I’m certainly not ready for the nursing home yet.”

The couple’s attorney, Virginia Johnson, said their case is far from unique. She said recent amendments to the catastrophic-health-care bill do nothing to make life simpler and more solvent “for the overwhelming percentage of the nation’s elderly or near elderly who need help at home, but aren’t nursing-home candidates.”

She also lamented a health-care system that encourages people to figure out ways to hide their assets from the government.

Must Pay Full Costs

Johnson was referring to the requirement that those who did not transfer their home or assets to a spouse, sibling or child at least two years before they were institutionalized must pay full costs for care as a private patient for up to 30 months.

“The catastrophic-care bill is not aimed to help the total numbers of people we’re dealing with. In fact, I think it makes financial survival easier for perhaps only 5% of the ailing old.”

While not sharing this bleak assessment, Mikulski’s staff agrees that the new provisions to prevent spousal impoverishment are only an important first step that will make life easier for hundreds of thousands of elderly.

Constance P. Carden, attorney with Legal Services for the Elderly in New York, concurs. She also makes the point that if all assets and income are in the ailing husband’s name, women are forced to sue their spouses in the nursing home for support--and not every state recognizes this court-ordered remedy.

“Instead, lots of couples made the wrenching decision to divorce so they could separate income from assets held by an ailing, confined spouse,” said Carden. “The Mikulski provision will be a godsend to many of our poorest clients. At least it will stop these court petitions.

“Prior to the changes, a person had to have less than $5,000 to qualify for Medicaid. No more was allowed in savings or assets, including the cash value of any insurance policy they held,” Carden said.

Split Combined Assets

Under the Mikulski provision, beginning Oct. 1, the community-based spouse is guaranteed anywhere from $786 a month to a $1,200. Couples can split their combined assets up to a maximum of $60,000. They are guaranteed a minimum of $12,000 in assets, or half of a combined estate of $24,000.

However, in states such as Nebraska, where nursing homes are already overwhelmed with non-paying Medicaid patients, the banks are threatening to put liens against houses held by community-based spouses and to call the liens in should the state health system go bankrupt.

Attorney Johnson predicts that scenario will become commonplace “once the baby-boom generation starts pounding at the nursing-home doors.”

According to Alfred Chiplin, staff attorney with the National Senior Citizens Law Center in Washington, while the Mikulski amendment lays a foundation for individual estates to decide how they are going to do property separations, “they do nothing to help millions like the Justices who are ill but want to stay at home.”