How Married Couples Can Protect Assets When One Spouse Needs a Nursing Home

When one spouse requires nursing home care and applies for Medicaid, the spouse who remains at home is called the community spouse. Federal law — specifically the Medicare Catastrophic Coverage Act of 1988 — established a set of protections for the community spouse that remain in effect today.

These protections apply regardless of how assets are titled. Even if all assets are in the nursing home spouse's name, the community spouse is still entitled to their protected share. The law looks at the couple's combined assets as of the snapshot date — typically the first day of the month the nursing home spouse was admitted to a facility for 30 or more consecutive days.

The Community Spouse Resource Allowance (CSRA) is the amount of countable assets the community spouse is permitted to keep when the nursing home spouse applies for Medicaid. In 2026, the CSRA ranges from a minimum of $30,828 to a maximum of $154,140, depending on the state.

The CSRA is calculated as half of the couple's combined countable assets as of the snapshot date, subject to the state's minimum and maximum limits. For example, if a couple has $200,000 in countable assets, the community spouse would be entitled to keep $100,000 — which falls within the 2026 federal range in most states.

Assets above the CSRA must generally be spent down before the nursing home spouse qualifies for Medicaid. However, there are legal strategies — including Medicaid-compliant annuities and other planning tools — that can convert excess countable assets into protected income or exempt assets for the community spouse.

In addition to asset protections, federal law also protects the community spouse's income. The Minimum Monthly Maintenance Needs Allowance (MMMNA) ensures that the community spouse retains enough monthly income to meet basic living expenses.

In 2026, the MMMNA ranges from $2,555 to $3,854 per month, depending on the state and the community spouse's housing costs. If the community spouse's own income falls below this threshold, they are entitled to receive a portion of the nursing home spouse's income to make up the difference — a process called the monthly maintenance needs allowance diversion.

This income protection is often overlooked in planning discussions, but it can be critically important for community spouses who have little income of their own. A Medicaid planning specialist can help calculate the exact allowance and ensure the community spouse receives everything they are entitled to.

The primary residence is generally exempt from Medicaid's asset calculation as long as the community spouse lives there. The nursing home spouse's equity interest in the home is not counted as a resource while the community spouse remains in the home.

However, Medicaid estate recovery rules may allow the state to seek reimbursement from the home after both spouses have passed away. Planning strategies — including certain trust arrangements and life estate deeds — can protect the home from estate recovery while preserving the community spouse's right to live there.

Married couples often have more planning options available than single individuals. Beyond the baseline CSRA and MMMNA protections, strategies such as Medicaid-compliant annuities, spousal refusal (in states that permit it), and asset conversion can significantly increase what the community spouse retains.

The specific strategies available depend heavily on the state, the couple's asset composition, and the timing of the application. Working with a Medicaid planning specialist who understands both federal law and your state's specific rules is essential to maximizing the community spouse's protection.