Medicare 2026

Spousal Impoverishment Rules for 2026: What the At-Home Spouse Can Keep

When one spouse needs long-term care and the family turns to Medicaid for help paying for it, a set of federal rules kicks in to protect the spouse who stays at home. These "spousal impoverishment" rules exist so that paying for a nursing home or other institutional care doesn't leave the at-home spouse without enough to live on. If you're trying to plan ahead, here's a plain-English look at how the 2026 numbers work and what the at-home spouse — often called the "community spouse" — can keep.

Where these rules come from

The rules live in section 1924 of the Social Security Act. They apply when a married person applies for Medicaid coverage of certain long-term services and supports — most often nursing facility care, but sometimes home- and community-based services as well. The rules protect income and resources for the community spouse so that the couple isn't forced to spend down everything they've saved together.

Medicaid is administered by each state within federal guidelines, so the specific procedures, forms, and even some dollar limits can vary. The ranges and minimums described below are the federal standards that every state must work within for 2026.

How resources are counted at the start

When a spouse begins what's called a "continuous period of institutional care," the state takes a snapshot. It totals up the countable resources owned by either spouse — savings, investments, and other assets — regardless of whose name they're in. It then calculates a "spousal share" equal to one-half of that total.

That spousal share, within federal limits, is what the community spouse gets to keep. For 2026, effective January 1, the community spouse resource standard is a minimum of $32,532 and a maximum of $162,660. States can set their protected amount anywhere in that range. Anything above the protected amount is generally considered available to the spouse who needs care and must be used toward their care before Medicaid will pay.

Certain assets — like the couple's home (within limits), one vehicle, and personal belongings — are typically not counted. The details vary by state.

How income is treated once care begins

Here's where many families are surprised: once the spouse needing care is in an institution, none of the community spouse's own income counts as available to the spouse receiving care. In other words, if the paycheck, pension, or Social Security benefit is in the community spouse's name alone, they keep it.

The general rule is that income paid solely in one spouse's name belongs to that spouse. Income paid in both names is split in half.

The monthly allowance for the community spouse

Federal law also guarantees the community spouse a minimum level of monthly income, called the Minimum Monthly Maintenance Needs Allowance (MMMNA). If the community spouse's own income falls below this floor, income from the institutionalized spouse can be shifted over to make up the difference.

As of July 1, 2026, the federal MMMNA is $2,705 per month in most states. (Two states outside the contiguous U.S. have higher amounts.) The maximum monthly maintenance needs allowance for 2026 is $4,066.50.

An excess shelter allowance can raise the floor if housing costs are high. The federal housing allowance used to decide whether this applies is $811.50 in most states as of July 1, 2026.

A quick note on timing: the minimum allowance and the housing figure are adjusted each July 1 based on changes in the federal poverty level, while the maximum income allowance and the resource minimum and maximum are updated each January.

If a couple believes these standard amounts aren't enough because of exceptional circumstances causing significant financial hardship, either spouse can request a higher allowance through a fair hearing.

The home and the home equity limit

The couple's primary home is usually not a counted resource while the community spouse lives there. But states do apply a home equity limit for the Medicaid applicant. For 2026, each state must set that limit at no less than $752,000 and no more than $1,130,000.

Importantly, this home equity limit does not apply if the applicant's spouse, a child under 21, or a blind or disabled child lawfully lives in the home.

A change is coming in 2028. Under a 2025 federal law (Public Law 119-21, section 71108), starting January 1, 2028, for homes that are not on land zoned for agricultural use, the highest limit a state may choose will be capped at $1,000,000. This is worth knowing if long-term planning is on your mind.

How this fits with Medicare

Medicare and Medicaid are different programs. Medicare generally does not pay for long-term custodial care in a nursing facility, which is why so many families end up looking at Medicaid when care needs are long-lasting. People who end up with both Medicare and Medicaid have extra options, including a monthly Special Enrollment Period to switch stand-alone Part D plans or move to Original Medicare with a stand-alone Part D plan, and full-benefit dual-eligible individuals can join an integrated D-SNP in any month.

Where to go next

Spousal impoverishment rules can be technical, and every state applies them slightly differently within the federal framework. For general Medicare questions, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24/7. For Medicaid-specific questions, your state's Medicaid agency is the best starting point.