Medicaid: Protections for Spousal Income During Long-Term Care

When your spouse goes to a nursing home, you can retain some income and assets and still qualify for Medicaid.

By , J.D. · University of Virginia School of Law

What happens when one spouse goes to a nursing home or assisted living, or starts to receive Medicaid-paid at-home care?

Medicaid doesn't require a healthy spouse to give up all of her income and property so the spouse needing care can qualify for long-term care through Medicaid. Instead, Medicaid has a set of rules called "spousal impoverishment protections" that allow the spouse of a nursing home or assisted living resident (or someone receiving at-home care though Medicaid) to keep enough income and assets to live on. The details of the states' spousal protections rules vary, but the basic guidelines are the same in every state.

When Do Spousal Protection Rules Apply?

The spousal protection rules kick when one spouse starts to receive Medicaid-paid long-term care and the other spouse does not.

The federal government has long required states to have spousal protection rules for Medicaid recipients who are in nursing homes, but until recently, they weren't required to have spousal protection rules for other Medicaid recipients, like those receiving in-home care. All states now should have rules protecting the income and/or assets of spouses of Medicaid recipients getting long-term care outside of nursing homes.

What Spousal Income is Protected?

Spouses of long-term care patients receiving Medicaid are allowed to keep all of their own income, and they may be able to keep some of their spouse's income if they need the financial support. The amount of money that a spouse can keep, and that is exempt from the Medicaid eligibility calculation, is called the "monthly maintenance needs allowance" (MMNA).

The MMNA varies from state to state, but the federal government sets a minimum and a maximum periodically that is tied to poverty guidelines. The minimum amount that a state must allow a community spouse in 2024 to keep is $2,465 per month, and the maximum is $3,853.50 (this amount changes each year in July).

About 15 states, including California, Illinois, Texas, and New York, allow the healthy spouse to keep up to the maximum amount of their spouse's income: $3,853.50 per month.

But many states use two set of figures, a lower figure, called the "minimum monthly maintenance needs allowance" (MMMNA), and a higher figure, called the "maximum monthly maintenance needs allowance." In these states, if the at-home spouse has housing costs that are higher than a certain amount, they're entitled to keep more income, up to the maximum monthly maintenance needs allowance. In 2024, the maximum MMNA amount is $3,853.50 in all states except Alabama and North Dakota. About 33 states use $2,465 as their minimum MMNA.

That amount of income is disregarded by the state Medicaid agency in evaluating whether the "needy" spouse (the spouse who needs care) is financially eligible for Medicaid.

What Spousal Assets are Protected?

In all states except for California, Medicaid applicants can't have many assets. But the spouse not receiving Medicaid-paid long-term care is allowed to keep some assets.

A spouse is allowed to keep part of the couple's marital assets ("resources"), subject to a minimum and maximum that is set by each state Medicaid agency, according to federal guidelines.

The amount of resources that the healthy spouse (the "community spouse") is allowed to keep is called the community spouse resource allowance (CSRA), and it varies by state. Medicaid sets a minimum and maximum CSRA that the states' CSRAs can fall within, but the states are allowed to choose from a wide range.

As with the MMNA, states use the community asset allowance in two different ways. Many states use both a minimum CSRA and a maximum CSRA. In 2024, the minimum CSRA is typically $30,828, and the maximum CSRA is $154,140 (the state can't allow the community spouse to keep more assets than that).

In these states, the at-home spouse is able to keep half of the couple's combined assets up to the maximum CSRA. But if the at-home spouse's half of the assets don't reach the minimum CSRA, then the at-home spouse can keep most or all of the assets, up to the minimum CSRA.

About a dozen other states use just one figure: The at-home spouse can retain most or all of the couple's assets up to the single CRSA standard in that state. Most states use a maximum of $154,140, but some states have a lower standard, as in Illinois and South Carolina.

You should check with your state's Medicaid agency to find out how much in resources you are allowed to keep if your spouse enters a nursing home or assisted living facility, or starts to receive Medicaid-paid at-home care.

If the spouse living in the community needs more income than the MMMNA or more resources than the CSRA, the spouse can seek a court order allowing a variation from the state agency's standard.

How a Couple's Home Is Protected

Federal Medicaid rules protect a Medicaid recipient's home and the property the house is on, and that's an important protection for spouses who remain in the community.

If a recipient thinks they will return to the home at some point, the first $713,000 in equity is excluded as a resource when the state calculates whether the needy spouse is eligible for Medicaid. (And some states choose to raise the equity limit to as much as $1,071,000.)

For instance, if you and your spouse have equity in your house worth $700,000, and no other countable assets, and your spouse needs to go to a nursing home, your spouse should qualify for Medicaid if they plan on returning to live in the house again someday.

However, states have discretion about when they'll disregard the value of a home when calculating eligibility; many states require that the recipient be likely to return to the home, not just that the recipient intends to return to the home.

After the spouse who received Medicaid-paid long-term care passes, the state Medicaid agency may try to collect payment from the Medicaid recipient's estate, including the house. But if the Medicaid recipient lawfully transfers it out of their name, including into their spouse's name or into an irrevocable trust, the house can't be taken for Medicaid reimbursement.

Learn more about transferring your house when one spouse starts receiving long-term care.

For information on Medicaid-paid long-term care, see our article on when Medicaid will pay for nursing home care or assisted living.

Updated March 19, 2024

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