Paying for care

Spousal Impoverishment Rules 2026: What a Spouse Keeps

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By Nursing Home Checker · Updated Oct 15, 2026 · How guides are checked · Share

These federal rules are often called the spousal impoverishment rules. They are in the Medicaid law at 42 U.S.C. 1396r-5, and they take priority over other Medicaid eligibility rules that conflict with them. The law calls the spouse in the nursing home the "institutionalized spouse" and the spouse at home the "community spouse."

When do the spousal impoverishment rules apply?

They apply when one spouse is in a nursing home or other medical institution and is likely to stay there at least 30 days in a row, while the other spouse is not in an institution. Federal law applies these spousal rules only in the 50 states and the District of Columbia, so they do not cover Puerto Rico or the US territories. The rules cover both the couple's assets (called resources) and their income. For the general Medicaid limits for a single person, see how Medicaid pays for a nursing home.

How much can the spouse at home keep in 2026?

In 2026, each state's asset standard for the spouse at home falls between $32,532 and $162,660, and the monthly income standard falls between $2,705 and $4,066.50. CMS publishes these federal figures each year.

The asset figures and the maximum income standard change each January. The minimum income standard and the housing amount change each July 1. From July 1, 2025, to June 30, 2026, the minimum income standard was $2,643.75 a month ($3,303.75 in Alaska, $3,040.00 in Hawaii). Federal law raises the asset figures and the maximum income standard each year by the change in the consumer price index; the minimum income standard and the housing amount follow the federal poverty line. Federal law says the home equity limit does not apply while a spouse lawfully lives in the home; see can a nursing home take your house.

How is the asset allowance for the spouse at home figured?

The spouse at home keeps the largest of four amounts, called the community spouse resource allowance. Federal law lists them:

• The state's standard. Each state sets its standard somewhere between the federal minimum ($32,532 in 2026) and the federal maximum ($162,660).
• Half of the couple's assets (the "spousal share"), up to the federal maximum.
• An amount set at a fair hearing.
• An amount transferred under a court order for the support of the spouse at home.

The allowance is a protected amount, not an extra amount on top of the spouse's own assets. Federal law subtracts the resources the spouse at home already has from the allowance. When the resident applies, all assets held by either spouse or both are counted as available to the resident, except the amount protected for the spouse at home. Assets that the SSI rules do not count are also not counted here. After the resident is approved, the protected amount can be moved to (or for the sole benefit of) the spouse at home without a transfer penalty; federal law says this transfer is to be made as soon as practicable after the first eligibility decision. For transfer penalties in general, see Medicaid's 5-year look-back.

Once the resident is found eligible, the assets of the spouse at home are no longer counted for the resident during the continuous stay. Federal law also lists limited exceptions where extra assets do not make the resident ineligible, including when the state decides that denial would work an undue hardship. To read how assets above the limit are handled, see Medicaid spend down for nursing home care.

What is the snapshot date?

The snapshot date is the start of the first continuous stay in a medical institution or nursing home. Federal law has the state add up the couple's countable assets as of that date, whichever spouse owns them. Half of that total is the spousal share. Either spouse can ask the state to assess and document the total, even before applying. The state must give each spouse a copy and must include notice of the right to a fair hearing. If the request is not part of an application, the state may charge a fee.

Whose income counts?

The income of the spouse at home is not counted as available to the resident. For figuring how much of the resident's income goes to the spouse at home, federal law generally treats income paid only in one spouse's name as that spouse's income. Income paid in both names is split in half, unless the paperwork says otherwise. The resident can show by evidence that ownership is different. Income from a trust follows separate rules.

How is the monthly income allowance figured?

If the spouse at home has less income than the state's monthly standard, part of the resident's income can make up the difference. This is the community spouse monthly income allowance. The state's standard must be at least 150% of one-twelfth of the federal poverty line for a family of two, plus any excess shelter allowance, up to the federal maximum ($4,066.50 in 2026).

The excess shelter allowance applies when the at-home spouse's housing costs are high. Federal law counts rent or mortgage (principal and interest), taxes and insurance, and any required condo or co-op maintenance charge for the home, plus the state's standard utility allowance (or actual utility costs if the state has no standard allowance). The part above the housing amount ($811.50 a month since July 1, 2026, in all states except Alaska and Hawaii) can raise the standard, up to the maximum.

After the resident qualifies, the state takes these amounts from the resident's income, in this order:

1. a personal needs allowance for the resident (see the personal needs allowance by state);
2. the income allowance for the spouse at home, but only to the extent the income is actually made available to the spouse;
3. a family allowance for minor or dependent children, dependent parents or dependent siblings who live with the spouse at home;
4. certain medical expenses not paid by a third party.

The rest of the resident's income goes toward the nursing home bill. If a court has ordered the resident to pay monthly support to the spouse at home, the income allowance may not be less than the ordered amount.

Can the allowance be raised at a fair hearing?

Yes. Once an application has been made, either spouse can ask for a fair hearing about the income allowance, whose income or assets count, the spousal share or the asset allowance. A hearing on the asset allowance must be held within 30 days of the request. When the resident is found eligible, the state must tell both spouses the income allowance, any family allowance, how the asset allowance is figured, and that they can ask for a fair hearing.

• Income. The income allowance is raised if either spouse shows that the spouse at home needs more income because of exceptional circumstances resulting in significant financial duress.
• Assets. If the income from the protected assets would not bring the at-home spouse up to the monthly standard, a larger asset amount is substituted. Before allowing that, the state must first count the resident's income that could be given to the spouse at home, as if it had been given.

Do the rules apply to home care Medicaid?

Yes, through September 30, 2027. Federal law applies the same spousal protections to married people eligible for certain Medicaid home and community-based services from January 1, 2014, through September 30, 2027. Federal law also lets a state disregard the spouse's income and assets for some of these programs instead. This reflects federal law as of October 2026.

Where to get the numbers for your state

In the 50 states and the District of Columbia, the state Medicaid agency sets its own standards within the federal range and figures the amounts for each couple. Federal law applies these spousal rules only in the 50 states and the District of Columbia (42 U.S.C. 1396r-5(a)(4)(B)), so they do not cover Puerto Rico or the US territories, even though Puerto Rico's Medicaid program is listed below. For example, California's Medi-Cal letter for 2026 lists $162,660 for assets and $4,067 a month for income, starting January 1, 2026; the asset figure applies to cases decided on or after that date. Each state page on this site, such as the California nursing homes page, lists the agency's contact details where they have been checked.

To find homes in an area that take Medicaid, read how to find nursing homes that accept Medicaid.