Same boat here. My spouse has numerous health issues that are mostly manageable, but the physical limitations make employment difficult and the Medicaid health plans are such as PITA to deal with that they may as well not be there. My spouse has extremely low self-esteem beat into them since childhood by an asshole stepfather (that over two decades I’ve only minimally been able to improve), and thus no drive to fight for the help that is needed. Me going would likely mean the end for both of us.