Medicaid and the Spouse at Home: Income and Savings a Community Spouse Can Keep

When one spouse moves to a nursing home and applies for Medicaid, the other spouse does not have to spend every last dollar. Federal rules protect the spouse who stays at home. That spouse is called the community spouse. The spouse in the nursing home is the applicant.

This guide explains the two main protections: a savings allowance and a monthly income allowance. All amounts are the federal standards for 2026. Your state sets the exact amounts inside the federal ranges, so treat the ranges as the frame and ask your state for its own numbers. Our Paying for Care section holds our other cost guides, and our guide on paying for care when savings run low shows the order families tend to follow.

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The savings a spouse can keep

Medicaid counts the couple's savings together at the time of the application. The community spouse then keeps a share of that total. The share is the community spouse resource allowance.

For 2026, the allowance is at least $32,532 and at most $162,660 (Ledger D4). States use their own method inside that range. Some states let the spouse keep half of the couple's countable savings, up to the maximum. Some states set one fixed amount. Your state Medicaid office can state its method in one call.

Countable savings include bank accounts, investment accounts, and most assets the couple can turn into cash. The home the community spouse lives in is not counted as a resource. One car and household goods are also left out of the count under the standard rules.

Savings above the amount the community spouse can keep must be dealt with before Medicaid will pay. Families handle that part in many ways. Our guide on Medicaid spend down covers the common paths and the records to keep.

The income a spouse can keep

Income works in a different way from savings. Each spouse's income is counted under their own name. The community spouse keeps all of their own income. No cap in this guide applies to income that is in the community spouse's own name.

If the community spouse's own income is low, part of the applicant's income can be shifted to them. The shift is the monthly maintenance needs allowance. From July 1, 2026, the minimum amount is $2,705 a month in all states except Alaska and Hawaii, where it is higher (Ledger D5). The most the allowance can reach in 2026 is $4,066.50 a month (Ledger D6).

Shelter costs can raise the amount. When rent, mortgage, taxes, insurance, and utility costs pass a set level, a housing allowance of $811.50 a month can be added for 2026 (Ledger D7). The state works out the exact figure from the couple's real bills, so keep the bills and bring them to the application.

After the shift, the rest of the applicant's income goes toward the nursing home bill. Medicaid pays the balance of the covered cost.

The applicant's own limits

The protections above sit next to strict limits for the applicant. The applicant's countable resources are held to $2,000 for one person (Ledger D3). In a state with an income cap, the applicant's income must be at or below $2,982 a month for 2026 (Ledger D2). That cap is three times the federal Supplemental Security Income rate.

These limits are why timing matters. A couple who asks about the allowances before the application can use the full protection the rules give. A couple who spends first and asks later may spend savings the spouse was allowed to keep.

Who pays for what

• Medicare pays for short rehab stays after a hospital stay under its own rules. Medicare does not pay for long-term nursing home care.
• Medicaid pays the nursing home for long-term care once the applicant meets the income and resource tests, with the applicant's income, after the spouse's allowance, paid toward the bill first.
• The community spouse keeps their own income, the resource allowance in Ledger D4, and any income shifted under the monthly allowance in Ledger D5 and Ledger D6.
• Private pay: the family pays the nursing home in full until Medicaid coverage starts, and pays for any item Medicaid does not cover.

Sample situation

Tom and Ana have been married for 48 years. Tom needs nursing home care and will apply for Medicaid. Ana will stay in their home. The couple's countable savings total an amount that puts Ana's share inside the 2026 federal range of $32,532 to $162,660, and their state sets her exact share inside that range (Ledger D4). Ana's own income is below $2,705 a month, so part of Tom's income is shifted to her to bring her monthly income up toward that minimum level, which took effect on July 1, 2026 (Ledger D5). Their shelter costs are high, so the state also weighs the $811.50 housing allowance (Ledger D7). Tom's own countable resources are brought to the $2,000 standard before his coverage starts (Ledger D3). Ana keeps the home, her income, and her share of the savings, and Medicaid pays the nursing home for the covered cost that Tom's remaining income does not cover.

Steps to take before you apply

• Ask your state Medicaid office which resource allowance method your state uses, and get the exact amount in writing.
• List all of the couple's accounts and assets before the application date.
• Gather shelter bills for the home: mortgage or rent, taxes, insurance, and utilities.
• Do not give away or spend savings to fix the count before you learn what the spouse can keep.

Sources

• https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf
• https://www.medicaid.gov/medicaid/eligibility/index.html