Health & Benefits

Medicaid can be used to help cover the costs of a senior citizen living in a residential care facility. But, Medicaid has rules that govern both the assets and the income of recipients. If the person going into a residential care facility is married and their spouse plans to keep living at home, the spouse that stays at home is called the "community spouse." 

The Community Spousal Impoverishment Act protects the community spouse so they aren't left without any income or assets. A Medicaid recipient with a spouse at home also may not need to spend-down the same as an unmarried person. Learn more about the spend-down process with Medicaid.

Assets

If a Medicaid recipient lives in a nursing home and has a spouse, there are special rules. This is so the spouse who does not live in the nursing home can have enough money to pay for their own expenses.

The Medicaid recipient living in a nursing home who is eligible under the Aid to the Aged, Blind, and Disabled (AABD) program can keep non-exempt assets totaling $17,500. The spouse who continues to live in the community can keep non-exempt assets, up to $135,648, as of 2025. This is called the Community Spouse Resource Allowance (CSRA).

The spouse in the nursing home may transfer assets to the community spouse.

Example: Sam lives in a nursing home. His wife, Mary, lives in their house. Sam's assets include a $40,000 Certificate of Deposit. Mary's assets include a $20,000 savings account. Sam and Mary also own a joint savings account with a balance of $10,000. Because Mary's assets are below the CSRA, Sam may transfer his assets to Mary up to the amount of the CSRA. In this case, Sam may transfer all of his assets to Mary, because the total value of the combined assets ($70,000) is less than the CSRA of $135,648.

Income

For Medicaid recipients living in nursing homes, there are special rules regarding income. The spouse in the nursing home may keep income of only $30 per month (or $90 if they get veteran’s benefits). If the spouse in the community (i.e. "community spouse") has an income below $3,948, the nursing home spouse may transfer income to them up to that limit. This is called the Community Spouse Maintenance Needs Allowance (CSMNA). 

Example: Sam lives in a nursing home. His wife, Mary, lives in their house. Sam's monthly income is Social Security of $900 and a pension of $200. Mary's monthly income is Social Security in the amount of $500. Because Mary's income is below the CSMNA of $3,948, Sam may transfer his income to Mary, up to that amount. In this case, Sam may transfer all of his income to Mary, because the total value of the combined monthly income ($1,600) is less than the CSMNA.