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I don't see a downside to this as I read that they can only sue for what Medicaid has paid which about half of what you would pay privately.
But maybe I am missing something.

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Spousal refusal is legal in NYS and Florida. It's not fraud.

https://www.elderlawanswers.com/medicaid-spousal-refusal-just-say-no-12156
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anonymous972110 Nov 2019
Good to know.
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I have no experience with NYS & defer to Barbs expertise on NY.
But for my state, LA, if a spouse goes the spousal refusal route, it can morph into your being removed from any ANY input on your spouses care. Kinda no pay = no say. If N.Y. does this, Would you want that??
for LA there will be likely a court appointed guardian or conservator for them. They will have the ability to do whatever with his monthly income & his share of community property in addition to where he lives. It can get quite messy, especially if you have a home and your living in the home & plan to continue doing that & have shared debts.

if you’re all new to just wtf LTC Medicaid is, for a community spouse situation, to me it’s flat not a diy project. Your going to be best to gather together your & his financials and see a CELA level of elder law attorney. There’s lots of fear mongering on couples Medicaid & easy to make financial/ asset mistakes in a panic. Medicaid does not, again DOES NOT, expect or require the community spouse (CS) to impoverish themselves in order for the LTC NH spouse to be eligible for Medicaid. Like your own monthly income is not a factor for his eligibility...... but how to perhaps structure assets to become income for you or use assets to enable you to afford your in the community lifestyle for your future or how to be eligible for the max CSRA (community spouse resource allowance) needs to be evaluated as to just how your states Medicaid looks at assets & income.
It’s not as simple or straightforward like the rules for widow or widower LTC NH Medicaid are. Personally I think that if a dpoa has been involved with the elders / parents life they can totally diy the elders LTC Medicaid application. But CS/NH is complicated.

NYS based on posts on this forum, seems to be a very very good state for how state runs LTC program; pretty generous and flexible especially for NYC. Id suggest you meet with an atty to see what options are best for the both of you.
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I wouldn't try spousal refusal without the advice of an eldercare attorney.
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It would be Medicaid fraud to refuse to pay if you had the assets to do so. I know the outcome for that would be.
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