When one spouse needs nursing-home care, Medicaid does not require the couple to spend everything. Federal spousal-impoverishment rules let the spouse at home keep a protected amount of the couple's resources and, when that spouse's own income falls short of a minimum monthly level, receive part of the other spouse's income, while the spouse in care qualifies. The exact amounts, and many of the steps, depend on the state.
Most people reading this are a husband or wife watching a spouse move into a nursing home, or toward one, while still living in the house they share. The worries tend to arrive together: whether the savings will be gone, whether the house is at risk, and how the bills will get paid each month. This page walks through how the rules for married couples fit together, from the asset count to the look-back to what happens after a death.
What Medicaid's Spousal-Impoverishment Rules Actually Do
Congress wrote special rules for married couples in 1988, according to the Medicaid.gov Spousal Impoverishment page, so that the spouse living at home is not left "with little or no income or resources." Those rules sit in 42 U.S.C. § 1396r-5.
Two terms run through everything that follows. The institutionalized spouse is the husband or wife receiving long-term care, usually in a nursing home. The community spouse is the husband or wife who still lives at home. Under the federal rules, "a certain amount of the couple's combined resources is protected" for the community spouse, and some of the institutionalized spouse's income can be set aside for the community spouse too. CMS notes that the protections can also reach care received at home or in another community setting, not only in a nursing home.
Federal law sets this framework, but each state runs its own Medicaid program inside it. Figures, forms and procedures differ from one state to the next, so the federal numbers on this page are a starting point rather than any state's final answer. That caveat applies throughout.
This page covers Medicaid for long-term care only. It does not cover Medicare, private long-term-care insurance or veterans' benefits.
How Medicaid Counts Assets for a Married Couple
The count starts with a snapshot of the couple's resources at the moment care begins. Under 42 U.S.C. § 1396r-5(c)(1), the state totals the value of the resources in which either spouse has an ownership interest, as of the beginning of the institutionalized spouse's first continuous period of institutional care, and computes a "spousal share" equal to half. Either spouse can ask the state to assess and document that total.
A countable asset is one Medicaid counts toward the limit, such as bank accounts and investments. An exempt asset is one it leaves out. Under 42 U.S.C. § 1396r-5(c)(5), resources excluded under the federal SSI rules, and resources that would be excluded but for a limit on their total value, are not counted; how a state applies its exemptions to a particular asset depends on that state's current rules.
In plain terms, Medicaid treats the couple's resources as one pool, no matter whose name is on each account. When the institutionalized spouse applies, all the resources held by either spouse or both are treated as available to the applicant, "regardless of any State laws relating to community property," but only to the extent they exceed the greatest of the figures in § 1396r-5(f)(2)(A): a federal minimum or a higher amount the state 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 by which that greatest figure exceeds the resources otherwise available to the community spouse, and the institutionalized spouse may transfer that amount to the community spouse without a transfer penalty (§ 1396r-5(f)(1)). For 2026, the CMS standards chart gives a minimum resource standard of $32,532 and a maximum of $162,660, effective January 1, 2026, in the CMCS Informational Bulletin of April 27, 2026. A state may specify an amount above the federal minimum, up to the maximum.
The home faces a second, separate test. Being exempt from the asset count is not the same as passing the home-equity limit. Under 42 U.S.C. § 1396p(f), an individual is not eligible for nursing-facility or other long-term-care coverage when the equity interest in the home exceeds the limit, unless a spouse, a child under 21 or a blind or disabled child is lawfully residing in the home. When the community spouse lives there, that limit does not apply. The statute also provides for a hardship waiver process, and it does not prevent using a reverse mortgage or home equity loan to reduce the equity. For 2026, the CMS chart sets the federal home-equity limit between a minimum of $752,000 and a maximum of $1,130,000, effective January 1, 2026, and a state may elect an amount in that range. Single-state details, such as California Medi-Cal asset limits, are covered on separate pages.
Income Rules: What Each Spouse Is Allowed to Keep
Income is treated differently from assets. Generally, each spouse's income is looked at on its own, and the community spouse's own income is not used to pay for the institutionalized spouse's care. Once the institutionalized spouse is eligible, that spouse's income is applied monthly toward the cost of care after certain amounts are deducted first. Those deductions, listed in 42 U.S.C. § 1396r-5(d)(1), are a personal needs allowance, a community spouse monthly income allowance, a family allowance for certain dependents living with the community spouse, and amounts for incurred medical expenses.
The Minimum Monthly Maintenance Needs Allowance (MMMNA) is the monthly income level to which the community spouse's income is raised when it falls short, using part of the institutionalized spouse's income. Federal law sets the minimum and a maximum, and states set their own figure within that range. According to the CMCS bulletin, the federal minimum is adjusted each July 1, while the maximum is adjusted each January. The bulletin's 2026 chart lists a minimum of $2,705.00 for all states except Alaska and Hawaii ($3,381.25 in Alaska and $3,111.25 in Hawaii), effective July 1, 2026, and a maximum of $4,066.50, effective January 1, 2026. A state's own figure applies from the date that state sets.
When the spouse at home has too little income, the rules let money flow from the spouse in care to close the gap. If the community spouse's own income falls below the MMMNA, part of the institutionalized spouse's income can be made available to make up the difference, under 42 U.S.C. § 1396r-5(d)(2). Under 42 U.S.C. § 1396r-5(d)(6), a state must consider that all income of the institutionalized spouse that could be made available to the community spouse has been made available before it allocates additional resources to the community spouse to cover that difference. An excess shelter allowance for high housing costs can raise the figure. The specific amounts and methods vary by program.
The Look-Back Period and How Transfers Are Treated
The look-back period is the stretch of time before a Medicaid application during which the state reviews gifts and other transfers. Under 42 U.S.C. § 1396p(c)(1)(B)(i), the federal look-back is 60 months for any transfer made on or after February 8, 2006. Not every state uses the same look-back, so the period that governs a given application depends on that state's current rules.
A transfer "for less than fair market value" (a gift, or a sale for less than something is worth) inside that window can lead to a penalty period: months when Medicaid will not pay for long-term care. The number of months equals the uncompensated value transferred divided by the average monthly private-pay nursing-home cost in the state, and states may not round fractions down.
The penalty clock does not start when the gift is made. Under 42 U.S.C. § 1396p(c)(1)(D)(ii), the penalty starts on the later of the first day of a month during or after which assets were transferred and the date the person is eligible and would otherwise be receiving institutional-level care based on an approved application, but for the penalty period. A gift made four years ago and a gift made last month, both inside the look-back, are penalized the same way.
Moving assets between spouses works differently. A transfer of assets to the applicant's spouse carries no transfer penalty under 42 U.S.C. § 1396p(c)(2)(B)(i). The statute lists other exceptions, including transfer of a home to the spouse (§ 1396p(c)(2)(A)(i)). Separately, § 1396r-5(f)(3) provides that § 1396p does not apply to amounts transferred under a court order for the support of the community spouse. In a Medicaid crisis planning situation, penalty timing follows these same rules.