Nursing-Home Costs Can Empty a Couple’s Nest Egg. A 2026 Medicaid Rule Could Shield as Much as $162,660 for the Spouse at Home

When one husband or wife enters a nursing home, Medicaid’s asset limits can force a married couple to spend down nearly everything before help begins. But a little-known federal safeguard can change that outcome dramatically.

Consider a married couple. One spouse goes into a care facility after a stroke, while the other remains in the home they have shared for decades. Their savings are spread across checking accounts, CDs and a brokerage account, and total $400,000. The spouse at home worries Medicaid will require them to exhaust nearly all of it before paying a single bill.

Federal rules are designed to prevent that. A protection known as the Community Spouse Resource Allowance, or CSRA, preserves part of a couple’s countable assets for the spouse who stays in the community. Under the Centers for Medicare & Medicaid Services’ 2026 spousal impoverishment standards, the maximum community spouse resource standard is $162,660 and the minimum is $32,532. States set the protected amount within that range, or by formula, so the ceiling is not automatic everywhere. How much a family can protect depends on where they live.

Medicaid Pays for Long-Term Care That Medicare Does Not

The costs add up quickly. In 2024, the average monthly rate for a semi-private nursing home room was $9,277.

Medicare, the federal health insurance most people get at 65, can cover up to 100 days of skilled nursing care in a benefit period when the stay meets its requirements. But it does not pay for custodial care, such as help with bathing, dressing and eating. Medicaid is different: it is a joint federal-state program for people with limited income and assets, and it can cover extended nursing home care. To qualify, the spouse in the facility typically must reduce countable assets to a very low state limit, often $2,000.

Without spousal protections, that $2,000 threshold could leave the spouse at home with almost nothing. Congress created the CSRA rules to avoid that result.

How Medicaid Uses the Snapshot Date to Set the Protection

Medicaid totals the couple’s assets on a “snapshot date,” generally the first day of the first continuous institutional stay lasting at least 30 days. It counts all countable assets no matter which spouse legally owns them. Transferring the brokerage account into one spouse’s name alone does not change the calculation, because the caseworker still adds both spouses’ assets together.

After that, the state formula applies. In many states, the spouse at home keeps 50% of the couple’s assets, subject to the federal minimum and maximum. Other states are more generous and allow the community spouse to keep the full maximum regardless of the split.

Here is how the example couple would fare in a state that uses the half-split approach:

• Half of $400,000 is $200,000, which is above the ceiling, so the spouse at home keeps $162,660.
• The spouse in the facility keeps the small allowance allowed for the institutionalized spouse, usually $2,000 in most states.
• The remaining $235,340 must be spent down before the spouse in care can satisfy the asset test. That amount is roughly equal to 25 months at the 2024 national median cost for a semi-private nursing home room, though the money does not all have to go directly to the facility.

The minimum also matters for couples with less saved. If a couple has $60,000, half would be $30,000. Because that falls below the floor, the spouse at home would instead keep $32,532.

Income Is Measured Separately, With Its Own Floor

Income and assets are treated differently. Once the spouse in care qualifies, most of that spouse’s income generally goes toward care, though some income can be diverted to the spouse at home if the household income is too low. CMS sets the minimum monthly maintenance needs allowance at $2,705, effective in the 2026 standards for every state except Alaska and Hawaii, with a maximum of $4,066.50. At the high end, that works out to $48,798 a year for the spouse still managing the household.

If the spouse at home still does not have enough income to meet that maintenance allowance, federal law allows either spouse to ask for a fair hearing and seek a larger protected resource amount.

Ask for a Spousal Resource Assessment Before Paying Privately

Some families begin paying privately before they understand the rules. Medicaid offers a formal way to answer the question first. Before making major payments, a family can request a spousal resource assessment from the state Medicaid agency. That review identifies the couple’s combined countable assets on the snapshot date and shows how much the spouse at home may keep.

For the couple in this example, the key issue is the $235,340 in excess countable assets. In a state that uses the full 2026 maximum, up to $162,660 can remain protected for the spouse at home instead of being lost to the spend-down. That money can help cover groceries, property taxes and home repairs.