When a husband or wife enters a nursing home, federal Medicaid law does not require the spouse at home to give up everything. The couple's countable assets are pooled, and the at-home spouse keeps a protected share and, if the spouse's own income falls short of a set level, a monthly income allowance, while the home is usually not counted. The exact amounts, and what happens to the home later, depend on the state's own rules.
Most people facing this are not reading out of curiosity. A husband has had a fall and will not come home from rehab. A wife's dementia now needs care around the clock. The spouse left at home, often with an adult child at the kitchen table, is trying to work out whether paying for that care means losing the savings, the house and the income they planned to grow old on. This page walks through how Medicaid's long-term-care rules treat a married couple, so that the questions to ask are clearer.
What Medicaid's Spousal Impoverishment Rules Actually Say
Congress wrote special rules for married couples in 1988 to keep the spouse at home from being left "with little or no income or resources," as the Medicaid.gov spousal impoverishment page puts it. Those rules sit in 42 U.S.C. § 1396r-5.
Two terms come first. The institutionalized spouse is the spouse who is in a nursing facility or other medical institution and is likely to stay there for at least 30 consecutive days. The community spouse is the spouse who stays at home. A countable asset is one Medicaid adds up against its eligibility limit, such as a bank account. An exempt asset is one it leaves out of that count.
Under 42 U.S.C. § 1396r-5(c)(2), when the institutionalized spouse applies, all resources held by either spouse, or both, are treated as available to the institutionalized spouse, "regardless of any State laws relating to community property," except for the share protected for the community spouse. Whose name is on an account does not decide the answer.
Federal law sets this framework, and every state must follow it. Each state then runs its own long-term-care Medicaid program, with its own limits, figures and procedures inside that framework. A federal rule is never automatically a particular state's rule.
This page covers Medicaid for long-term care only. It does not cover Medicare, private long-term-care insurance or veterans' benefits.
What the Community Spouse Is Allowed to Keep
The Community Spouse Resource Allowance (CSRA) is the share of the couple's combined countable assets that the at-home spouse may keep. Under 42 U.S.C. § 1396r-5(c)(1), the state totals everything either spouse owns "as of the beginning of the first continuous period of institutionalization" and computes half. That moment is often called the snapshot date. Either spouse can ask the state to assess and document the total, and the state must give each spouse a copy along with notice of the right to a fair hearing.
Federal law sets a floor and a ceiling for the standard CSRA amounts, adjusted each year. The CMS bulletin of April 27, 2026 gives a minimum of $32,532 and a maximum of $162,660, effective January 1, 2026. Under § 1396r-5(f)(2)(A), the protected amount is the greatest of four amounts: the minimum, or a higher figure the state's plan specifies up to the maximum; the spousal share, capped at the maximum; an amount set at a fair hearing; or an amount transferred under a court order. A state's own figure applies from the date the state's own page gives.
Some property is not counted at all. Section 1396r-5(c)(5) excludes resources that federal Supplemental Security Income rules exclude. The home is one example, subject to the equity limit discussed below. Which other items are exempt, and up to what value, depends on the state's current rules.
Income gets separate protection. The Minimum Monthly Maintenance Needs Allowance (MMMNA) is the monthly income level to which the community spouse's income can be raised. If the community spouse's own income falls short, part of the institutionalized spouse's income can make up the gap, as § 1396r-5(d) provides. The CMS bulletin sets the minimum MMMNA at $2,705 for all states except Alaska and Hawaii, effective July 1, 2026; an excess shelter allowance can raise a spouse's figure above that. It sets the maximum at $4,066.50, effective January 1, 2026. A state's own figure applies from the date that state's page states. For California's figures, see Medi-Cal asset limits; for Florida's, see Florida Medicaid planning.
The Family Home: Exemption, Equity Limits, and Estate Recovery
For many couples the house is the largest asset and the hardest one to think about. Federally, the home is generally not counted during the Medicaid recipient's lifetime, but that rule has limits.
Under 42 U.S.C. § 1396p(f), long-term-care Medicaid cannot be paid for someone whose home equity is above a set limit, unless a spouse, a child under 21 or a blind or disabled child lives in the home. Home equity means the home's value minus what is owed on it. The CMS bulletin gives a federal minimum home-equity limit of $752,000 and a maximum of $1,130,000, effective January 1, 2026. A state applies the lower figure unless it elects a higher limit, up to the maximum. When the community spouse lives in the home, the equity limit does not block coverage.
Estate recovery is the state seeking repayment, after a Medicaid recipient dies, of Medicaid costs paid, as 42 U.S.C. § 1396p(b) provides. For a recipient who was 55 or older when the assistance was received, the state must seek recovery for nursing facility services, home and community-based services and related hospital and prescription drug services, and may at its option seek it for other items or services. Under § 1396p(b)(2), recovery is delayed, not canceled, while a surviving spouse, a child under 21 or a blind or disabled child survives. What a state may recover from, including whether it reaches beyond the probate estate, depends on that state's own rules.
Placing the home in a trust does not automatically protect it from the asset count or from estate recovery. Whether it does depends on the type of trust, when it was created and the state's rules.