How Marital Status Changes the Rules

Long-Term Care Medicaid treats single, married, separated, divorced and widowed applicants differently. For married couples, federal law adds protections so that the spouse who stays at home is not left without money. Those rules can make a large difference in what a family keeps. This guide explains how each marital status is treated and points to the detailed guides.

Figures change periodically. Double-check current amounts before relying on them.

Single applicants

A single applicant (never married, divorced or widowed) is judged on their own income and assets alone.

• Assets: must be at or below the state’s limit, often $2,000 in 2026.
• Income: must meet the state’s rule, such as the $2,982 a month special income limit or a medically needy spend-down.
• After approval: most income goes to the cost of care, after a personal needs allowance (at least $30 a month under federal law; most states allow more).

There is no allowance for anyone else unless the person has a dependent family member at home in some cases.

Married couples: one spouse needs care

When one spouse needs nursing home care (or, in most cases, home and community-based waiver care) and the other stays at home, federal spousal impoverishment rules apply. The spouse who needs care is called the institutionalized spouse, and the other is the community spouse.

Assets

• All countable assets of both spouses are added together, no matter whose name they are in, as of the snapshot date.
• The community spouse keeps the Community Spouse Resource Allowance (CSRA): in 2026, at least $32,532 and up to $162,660, depending on the state’s rule and the couple’s assets.
• The rest must be reduced to the applicant’s limit.
• The home, one car and other exempt assets are protected in addition to the CSRA.

See The CSRA.

Income

• Only the applicant’s income counts toward the applicant’s eligibility in most states. The community spouse’s income is not counted.
• If the community spouse’s own income is below the Minimum Monthly Maintenance Needs Allowance (MMMNA), part of the applicant’s income can be paid to them. The minimum is $2,705 a month from July 1, 2026 (higher in Alaska and Hawaii), and the maximum is $4,066.50 a month in 2026, with adjustments for housing costs.

See The MMMNA and Income for couples.

Transfers between spouses

Transfers between spouses are not penalized under the look-back rules. But because both spouses’ assets are counted together at the start, simply moving money between them does not create eligibility. After approval, the CSRA is usually transferred into the community spouse’s name.

Married couples: both spouses need care

When both spouses need long-term care, the spousal impoverishment protections generally do not apply, because there is no spouse at home. States treat the couple in one of two ways, depending on the program and timing:

• as a couple, with a combined asset limit (often $3,000 where the single limit is $2,000);
• as two individuals, each with their own limit, once they are both in a facility for a period of time.

See When both spouses need care.

Separated spouses

Being separated does not end a marriage for Medicaid purposes in most cases. If spouses live apart, how they are treated depends on the circumstances and state rules. The spousal impoverishment rules generally still apply to a married applicant entering care, which means the other spouse’s assets may be counted at the snapshot, even if the couple has lived apart for years. The state may consider whether the absent spouse’s assets are actually available.

If the community spouse refuses to cooperate or to make assets available, federal law provides options in some cases, such as assigning support rights to the state. See Spousal refusal.

Divorce

Some couples consider divorce to protect assets. Under a divorce, assets are divided by the court or by agreement, and after the divorce each person is treated as single.

But divorce has serious drawbacks:

• a division that gives far more than half to the healthy spouse may be reviewed as a transfer;
• the healthy spouse loses the protections of the MMMNA and the CSRA;
• it can affect Social Security spousal and survivor benefits, pensions, health insurance and inheritance;
• it is emotionally difficult and costly.

It is rarely the best option. See Medicaid divorce.

Widowed applicants

A widow or widower is treated as single. Some points to watch:

• Inherited assets from the spouse count as the survivor’s assets. See Receiving an inheritance.
• Survivor benefits from Social Security or a pension count as income.
• Estate recovery that was deferred while the spouse was alive may begin after the survivor’s death, from what remains of the first spouse’s estate, depending on state law. See Estate recovery.

Unmarried partners

Couples who live together without being married are treated as two single people. Neither partner’s assets count for the other, but neither gets the spousal protections. Gifts between unmarried partners can be penalized under the look-back. A home owned jointly by unmarried partners is treated according to how title is held.

Same-sex spouses

Married same-sex couples are treated the same as any other married couple.

Comparing the outcomes

Consider a couple with $150,000 in countable assets, living in a state that lets the spouse at home keep half up to the maximum:

This is a simplified example, but it shows why marital status matters and why married couples often have more planning options.

Common questions

Does the healthy spouse’s retirement account count? In most states, yes. It is a countable asset of the couple. Some states treat it differently. See Retirement accounts.

Can the healthy spouse keep working? Yes. Their income is theirs and does not count toward the applicant’s eligibility in most states.

What happens if the healthy spouse dies first? The healthy spouse’s will should be reviewed. Leaving everything outright to the spouse in a nursing home can push them over the asset limit. Many planners suggest other arrangements, within state law and the spouse’s elective share rights.

What about a prenuptial agreement? Medicaid generally counts both spouses’ assets regardless of a prenuptial agreement.

Is common-law marriage recognized? Only if it is recognized under state law where it was formed.

Steps to take

1. Determine marital status as of the application date, with documents such as a marriage certificate or divorce decree.
2. For married couples, gather statements for both spouses’ accounts as of the snapshot date.
3. Review the healthy spouse’s will and beneficiary designations.
4. Talk with a Certified Medicaid Planner (CMP) before any transfers, retitling or divorce discussions.

The healthy spouse’s will

One of the most overlooked issues for married couples is the will of the spouse at home. If the healthy spouse dies first and leaves everything outright to the spouse in care, the inheritance can push the surviving spouse over the asset limit and end Medicaid until the money is spent.

Federal law treats a trust created by will differently from a trust a person creates during life. The Medicaid trust rules apply to trusts established “other than by will,” so a spouse can generally leave assets in a properly drafted testamentary trust for the spouse in care, often designed to supplement rather than replace Medicaid. State law may also give the surviving spouse a right to claim a share of the estate (an “elective share”), and some states treat a failure to claim it as a transfer. Because of these interactions, the healthy spouse’s estate plan should be reviewed as part of Medicaid planning.

Spousal protections at home

The spousal impoverishment protections apply to nursing home care, and federal law currently requires states to apply them to home and community-based services as well, through September 30, 2027, unless Congress extends the requirement again. Before that requirement, states could choose whether to apply them for home care. Families relying on a waiver should watch for changes.

Documents to gather

• marriage certificate, or divorce decree and any property settlement;
• death certificate of a late spouse;
• statements for both spouses’ accounts;
• both spouses’ wills, trusts, powers of attorney and beneficiary designations;
• any separation agreement or court support order.

When marital status changes after approval

A death, divorce or marriage after approval must be reported. A new marriage can bring the new spouse’s assets into the count for future eligibility decisions. A death can change the applicant’s income and assets.

Related guides

• Married couples and Medicaid
• Spousal impoverishment rules
• The snapshot date
• When both spouses need care

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.