When one parent enters a nursing home on Medicaid, the other parent stays home as the community spouse and does not have to become impoverished for the nursing-home spouse to qualify. The community spouse is the husband or wife who continues living at home, and federal spousal-impoverishment rules protect a share of the couple's assets, monthly income, and the home. For dementia care families, this protection shapes daily decisions about bills, savings, and housing. It does not make the spouse ineligible for help, and it does not require giving away the house or all savings first.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Official resources:
- https://www.medicaid.gov/medicaid/eligibility-policy/spousal-impoverishment — Use this page to check the study’s participation requirements.
- https://www.medicaid.gov/medicaid/eligibility-policy/estate-recovery — Use this page to check the study’s participation requirements.
Table of Contents
- How much of the couple's savings can the at-home spouse keep?
- How is monthly income split between spouses?
- Does Medicaid count or take the family home?
- Can you transfer assets to the at-home spouse?
How much of the couple's savings can the at-home spouse keep?
The at-home spouse may retain a Community Spouse Resource Allowance from countable couple assets. According to ElderLawAnswers reporting the 2025 CMS spousal-impoverishment figures, that allowance reached up to $157,920 in 2025, with a federal minimum of $31,584.
The exact amount depends on the state and the couple's countable assets. Countable assets generally mean bank accounts and investments, not the home the community spouse lives in. Families should ask the state Medicaid agency for a resource assessment early.
How is monthly income split between spouses?
The community spouse keeps all income in their own name, such as their own Social Security or pension. If that income falls below the Minimum Monthly Maintenance Needs Allowance, part of the nursing-home spouse's income can be diverted to close the gap. According to ElderLawAnswers reporting the 2025 CMS allowance figures, that support was floored at $2,555 per month and capped at $3,948 per month in 2025.
The cap and floor change yearly and vary by state shelter and utility rules. After that allowance and other deductions, the nursing-home spouse's remaining income generally goes to the facility as cost-share. Families should request the income-diversion calculation before paying the first bill.
Does Medicaid count or take the family home?
The couple's primary home is generally exempt from Medicaid asset counting while the community spouse continues living there. In that situation, no home-equity cap applies. Protection continues after death.
States may not pursue Medicaid estate recovery from a deceased recipient's estate while a surviving spouse is alive, according to the CMS estate recovery policy. The home is therefore shielded from recovery during the survivor's lifetime. This matters for spouses who plan to stay in the house long term. They should still keep proof of residence, ownership, and continued occupancy in one file.
Can you transfer assets to the at-home spouse?
Medicaid reviews transfers made in the 60 months before application. Transfers to a spouse, or for a spouse's sole benefit, do not trigger the transfer penalty.
Other gifts can cause a penalty period tied to the state's average nursing-home cost. Do not make large transfers to children or others to lower assets without advice.
- Ask for the asset assessment and the income-diversion calculation in writing
- Keep income in each spouse's name clear and documented
- Confirm current CSRA, income, and equity figures with the state agency, since federal standards are updated yearly and applied differently by state
