What can the spouse who stays home keep when the other enters a nursing home?

Who the rules cover

The statute that creates these protections is the spousal impoverishment section of the Medicaid law. It applies when one spouse is an “institutionalized spouse” and the other is not. The definition is narrower than a plain reading suggests: the person must be in a medical institution or nursing facility and be married to a spouse who is not in one, and the law leaves out anyone who is not likely to meet that test for at least 30 consecutive days. A short rehabilitation stay that ends in a few days does not start these rules.

The provisions supersede anything else in the Medicaid statute that is inconsistent with them, and they apply only in the 50 states and the District of Columbia. One piece of later legislation matters for families who are not in a nursing home at all. A 2010 law extended the same spousal protections to people receiving home and community-based services, and that extension has been kept alive by a series of short renewals, the current one running through September 30, 2027.

The resource side: the spousal share and the allowance

The resources are counted once, at the beginning of the first continuous period of institutionalization. The state adds up the total value of the resources in which either spouse has an ownership interest as of that date, and half of it is the spousal share. Everything downstream is built from those two numbers, so the date of the count matters more than the date of the application.

Either spouse can ask the state to do that count on paper before applying. The statute says the state must promptly assess and document the total and give each spouse a copy. If the request is not part of an application for Medicaid, the state may charge a fee, capped at the reasonable expenses of doing the work, and the notice sent with the copy has to say that the spouse has a right to a fair hearing.

Amounts as published by the Centers for Medicare & Medicaid Services for 2026. States set their figures within these floors and ceilings.

The allowance itself is built from a formula rather than a flat number. The statute takes the greatest of four amounts: the indexed base figure, which started at $12,000 and is $32,532 for 2026; the lesser of the spousal share or the indexed upper base figure, which started at $60,000 and is $162,660 for 2026; whatever a fair hearing has established; or an amount fixed by a court order. From that it subtracts the resources the community spouse holds in their own name, and the difference is what may be protected.

The two base figures rise with the consumer price index, which is why the numbers on older guides are so far below the current ones. At the same time as the allowance is computed, all resources held by either spouse are treated as available to the one applying, except to the extent they exceed the allowance. Once the institutionalized spouse has been found eligible, that stops: for as long as the institutional period continues, no resources of the community spouse are treated as available to the person in care.

The income side: what the community spouse's income is brought up to

Income is handled separately from resources, and the starting point is a protection rather than a deduction. During any month the institutionalized spouse is in the institution, the statute says no income of the community spouse is treated as available to them. For a married couple that is a real departure from the ordinary rules, under which one spouse's income is often counted when the other spouse's eligibility is worked out.

What follows is a calculation of how much of the institutionalized spouse's own income goes toward the cost of care and how much is diverted to the household. Four deductions come off the institutionalized spouse's monthly income, in this order:

1. A personal needs allowance, set by the state at or above a federal floor.
2. A community spouse monthly income allowance, but only as far as income is actually made available to the community spouse or spent for their benefit.
3. A family allowance for each family member, equal to at least one third of the amount by which the poverty-level figure used in the calculation exceeds that family member's own monthly income. Family members here means minor or dependent children, dependent parents, and dependent siblings who live with the community spouse.
4. Amounts already incurred for the institutionalized spouse's medical care.

The community spouse monthly income allowance is the difference between the minimum monthly maintenance needs allowance and the income the community spouse already has. That minimum allowance is 150 percent of one twelfth of the federal poverty line for a household of two, plus an excess shelter allowance. The excess shelter figure is the amount by which rent or mortgage payments including principal and interest, property taxes, insurance and any required condominium or cooperative maintenance charge, together with a utility allowance, exceeds 30 percent of that same poverty-line figure. The poverty line is revised annually, and the statute directs that a revision applies to care furnished after the second calendar quarter following publication. That is why these particular figures change on July 1 and not on January 1. If a court has ordered the institutionalized spouse to pay monthly support, the income allowance cannot be set below the ordered amount.

The income-first rule

There is a rule that decides the order in which help is given, and it was added in 2006. Before a state hands an extra slice of resources to the community spouse to make up a shortfall in income, it must treat all of the institutionalized spouse's income that could be made available to the community spouse as already made available. Income comes first and extra resources come second, even when the couple would rather protect the assets and use the income.

The practical effect is that a couple cannot usually argue for a bigger resource allowance while the institutionalized spouse's income sits unused. The two calculations are linked, and the resource allowance only grows after the income allowance has been exhausted.

Notice, hearings and increases

The state has to tell both spouses what it decided. On a determination of eligibility, or on a request from either spouse or their representative, the state must notify them of the community spouse monthly income allowance, any family allowances, the method it used to compute the resource allowance, and the right to a fair hearing.

A hearing can be asked for on any of the elements that decide the outcome: the income allowance, the income treated as available to the community spouse, the spousal share, the attribution of resources, or the resource allowance itself. A hearing about the resource allowance has to be held within 30 days of the request. Two kinds of increase can come out of it. Either spouse may show that the community spouse needs more income than the minimum allowance provides because of exceptional circumstances causing significant financial duress, in which case a higher income figure is substituted. Or either spouse may show that the resource allowance is not enough to raise the community spouse's income to the minimum allowance, in which case the state substitutes a larger resource allowance.

Moving the allowance across without a penalty

One provision makes the whole scheme workable. An institutionalized spouse may transfer an amount equal to the community spouse resource allowance to the community spouse, or to another person for the community spouse's sole benefit, and that transfer is not treated as a disposal of assets for the penalty rules. The transfer is supposed to happen as soon as practicable after the initial eligibility determination, allowing time for a court order if one is needed. A court-ordered transfer for the support of the community spouse or a family member is also outside the penalty rules.

This matters because the transfer-of-assets penalty is otherwise the rule that catches couples who try to move money around. Here the law carves out the allowance itself, so protecting it is not something the couple has to do quietly. The amounts are the same ones the state already recorded, and the statutory instruction is simply to carry them out. The wider penalty rules are set out on the look-back period guide, and the underlying asset categories on the countable assets guide.

Three things this is not

1. Not the SSI resource limits. Social Security counts resources for Supplemental Security Income against figures of $2,000 for one person and $3,000 for a couple in 2026. Those are the outer limits for that program. The community spouse allowances on this page are a different set of numbers, and they are much larger.
2. Not a fixed national figure. The government publishes floors and ceilings, and each state sets its own figure inside them. A state can also apply for and receive a higher resource allowance through the hearing route. Two couples with identical savings in two states can come away with different allowances.
3. Not advice you can act on from an article. The assessment, the spousal share and any hearing are handled by the state agency, and the outcome turns on documents from a particular date. The cost side of the same decision is on the nursing home cost page and the care cost calculator. Anything worth doing here belongs with somebody who applies this law.

Where these rules come from

The mechanics on this page were read from the spousal impoverishment section of the Medicaid law in the United States Code, section 1924 of the Social Security Act, as published by the Government Publishing Office in the 2023 edition: the definition of an institutionalized spouse and the 30-day rule, the separate treatment of the community spouse's income and resources, the computation of the spousal share and the right to an assessment, the order of the four income deductions, the definition of the community spouse monthly income allowance, the 150 percent poverty-line figure and the excess shelter allowance, the $12,000 and $60,000 base amounts and their indexing to the consumer price index, the cap on the income allowance, the income-first rule, the notice and fair hearing provisions and the 30-day hearing deadline, the two grounds for an increase, and the permission to transfer the resource allowance without triggering a penalty. The 2026 dollar figures are from the Centers for Medicare & Medicaid Services informational bulletin on the 2026 Supplemental Security Income and spousal impoverishment standards, dated April 27, 2026, which is also the source of the SSI benefit rates and resource standards quoted above, and of the home equity limits. The extension of these protections to home and community-based services comes from the 2010 law annotated under the same section of the Code. Care costs quoted on this site are the national medians from the survey named at the top of the page. The private-pay nursing facility rate that a state uses for other calculations is set by that state, so no figure for it appears here. Nothing on this page is legal advice.

For scale: the survey this site uses puts the 2025 national median for a semi-private nursing home room at $9,581 a month and a private room at $10,798. Those are the bills the community spouse allowances exist to keep from consuming both halves of a couple's savings.