When a husband or wife needs nursing-home Medicaid, the spouse at home does not have to give up everything. Under the federal spousal impoverishment rules, a share of the couple's savings is protected for the spouse at home, and part of the other spouse's income can be set aside if the at-home spouse's own income is low. Each state applies these protections through its own Medicaid program.
Most people facing this question are sitting with a spouse who has just entered a nursing home, or soon will, and a set of bank statements they have never had to read this way before. The worry is concrete: whether the house, the savings account and the monthly income will still be there for the spouse who stays home. Adult children often carry the same question for a parent. This page walks through the federal rules that answer it, the 2026 federal figures and the dates they apply from, and the points where the answer turns on the state.
What Spousal Impoverishment Means Under Federal Medicaid Law
"Spousal impoverishment" is the risk that the spouse still living at home would be left with too few assets or too little income to live on once the other spouse qualifies for Medicaid long-term care. Congress enacted protections against it in 1988, as Medicaid.gov's spousal impoverishment page explains. They are codified at 42 U.S.C. § 1396r-5.
Two terms carry the whole subject. The community spouse is the husband or wife who keeps living at home. The institutionalized spouse is the one in a medical institution or nursing facility who is likely to remain there for at least 30 consecutive days (42 U.S.C. § 1396r-5(h)(1)). The protections also reach married applicants receiving home- and community-based long-term care, according to the Medicaid.gov eligibility policy page, which describes them as protecting the spouse of someone who needs long-term services "in either an institution or a home or other community-based setting."
Federal law sets a standard minimum and maximum for the protected resource amount and a minimum and a cap for the monthly maintenance needs allowance, and a fair hearing or court order can lead to a higher amount. Each state runs its own Medicaid program inside those limits. These rules apply only when one spouse needs long-term care; a couple where neither spouse needs that care is not covered by them.
The Community Spouse Resource Allowance: What Assets the At-Home Spouse Keeps
A countable asset (also called a countable resource) is one Medicaid counts when it decides eligibility, such as bank accounts and investments. An exempt asset is one it does not count. Under 42 U.S.C. § 1396r-5(c)(5), resources excluded under the federal Supplemental Security Income rules are left out of the count; they include the home, household goods, personal effects and an automobile, and the list is partial. Which assets a particular state excludes can also depend on that state's rules.
Under 42 U.S.C. § 1396r-5(c)(1)(A), the state computes the couple's position "as of the beginning of the first continuous period of institutionalization." People call this the snapshot date. On that date the state totals "the value of the resources to the extent either the institutionalized spouse or the community spouse has an ownership interest," and computes "a spousal share which is equal to ½ of such total value." Either spouse can ask the state to assess and document that total; the statute adds that a state may charge a fee for the assessment if the request is not part of a Medicaid application.
At application, all resources held by either spouse are treated as available to the institutionalized spouse, but only to the extent they exceed the protected amount, which applies regardless of state community-property laws. That protected amount is the greatest of four figures under 42 U.S.C. § 1396r-5(f)(2)(A): a federal minimum (or a higher amount the state plan specifies, up to the federal maximum); the lesser of the spousal share and the federal maximum; an amount set at a fair hearing; or an amount transferred under a court order. The Community Spouse Resource Allowance (CSRA) is the amount, if any, by which that figure exceeds the resources otherwise available to the community spouse, and the institutionalized spouse may transfer an amount equal to it to, or for the sole benefit of, the community spouse without a transfer penalty (§ 1396r-5(f)(1)). Per the CMS bulletin of April 27, 2026, effective January 1, 2026, the federal minimum resource standard is $32,532 and the maximum is $162,660. These change each January 1.
The home is among the resources left out of the count. Under 42 U.S.C. § 1396p(f), long-term-care coverage is barred above a home-equity limit unless a spouse, a child under 21 or a blind or disabled child lives there. Effective January 1, 2026, the federal home-equity limits run from $752,000 to $1,130,000, per the same CMS bulletin.
The Minimum Monthly Maintenance Needs Allowance: Income the Community Spouse Keeps
Income runs on a separate track from assets. Medicaid.gov's post-eligibility calculation works from the institutionalized spouse's income: it deducts protected amounts from that spouse's income, and what is left goes toward care. The community spouse's own income is the starting point for deciding whether that spouse receives an extra allowance.
The Minimum Monthly Maintenance Needs Allowance (MMMNA) is the level of monthly income that each state must set for a community spouse under 42 U.S.C. § 1396r-5(d)(3). It is a level the community spouse's income can be raised to, not a limit on what that spouse may keep, because no income of the community spouse is deemed available to the institutionalized spouse while that spouse is in the institution (§ 1396r-5(b)(1)). If the community spouse's own income falls below it, the shortfall can be made up from the institutionalized spouse's income, but only to the extent that income is actually made available to the community spouse.
The MMMNA has two parts. One is 150 percent of one-twelfth of the federal poverty line for a two-person household. The other is the excess shelter allowance, which counts the community spouse's rent or mortgage (principal and interest), taxes, insurance, any required condominium or cooperative maintenance charge, and a standard utility allowance, to the extent the total exceeds 30 percent of that first part. Per the CMS bulletin, the federal MMMNA floor is $2,705 effective July 1, 2026 in all states except Alaska and Hawaii, and the maximum is $4,066.50 effective January 1, 2026. The floor changes each July 1; the maximum changes each January 1. If either spouse establishes at a fair hearing that the community spouse needs income above the MMMNA because of exceptional circumstances resulting in significant financial duress, the statute substitutes an amount adequate to provide the additional income needed (§ 1396r-5(e)(2)(B)).
After eligibility, the institutionalized spouse's income is reduced by, in order, a personal needs allowance, the community spouse income allowance, any family allowance and incurred medical expenses. The rest goes toward care.