Income for Couples: Whose Income Counts?

When a married person applies for Long-Term Care Medicaid, couples often worry that the spouse at home will lose their income too. In most cases, they will not. Long-Term Care Medicaid treats each spouse’s income separately, and it can even move part of the applicant’s income to the spouse at home. This guide explains how.

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

The “name on the check” rule

Under the federal spousal impoverishment rules, income is generally treated as belonging to the spouse whose name is on it:

A pension or Social Security check paid to the husband is the husband’s income.
A check paid to the wife is the wife’s income.
Income paid to both names (for example, interest on a joint account or rent from jointly owned property) is usually split half and half, unless documents show otherwise.

This rule applies whether or not the couple lives in a community property state, for purposes of figuring eligibility.

The spouse at home’s income is not counted for eligibility

When one spouse applies, only the applicant’s income is compared with the state’s income limit. The spouse at home’s income is not added in, and the spouse at home is not required to use their income for the applicant’s care.

For example, if the husband applies in a state with a $2,982 cap, and he has $2,200 a month while his wife has $3,500 a month, he qualifies on income. Her $3,500 is not counted and stays hers.

Income can be moved to the spouse at home

If the spouse at home’s own income is low, federal law lets part of the applicant’s income be paid to them each month. This is the community spouse monthly income allowance, figured from the Minimum Monthly Maintenance Needs Allowance (MMMNA).

2026 federal figure	Amount
MMMNA minimum, from July 1, 2026 (48 states and DC)	$2,705 a month
MMMNA minimum, Alaska / Hawaii	$3,381.25 / $3,111.25 a month
MMMNA maximum	$4,066.50 a month
Housing standard used for the excess shelter allowance	$811.50 a month

Source: CMS, 2026 SSI and Spousal Impoverishment Standards.

How it works

The state figures the spouse at home’s MMMNA: at least the minimum, plus an extra amount if housing costs are high (up to the maximum). Some states simply use the maximum.
The state subtracts the spouse at home’s own gross income.
Any shortfall can be paid from the applicant’s income to the spouse at home, after the applicant’s personal needs allowance.

Example

Sam is approved for nursing home Medicaid. His income is $2,800 a month. His wife Lucy’s income is $1,000 a month. Lucy’s MMMNA, after a housing adjustment, is $3,000.

Lucy’s shortfall: $3,000 − $1,000 = $2,000.
Sam keeps his personal needs allowance (say $70), and up to $2,000 of his income goes to Lucy.
The rest, about $730 minus any health insurance premiums, goes to the nursing home.

See MMMNA for the full calculation.

Income in income cap states

In states with an income cap (often $2,982 a month in 2026), only the applicant’s income is measured against the cap. If the applicant is over the cap, a Qualified Income (Miller) Trust may be needed. Money paid into the trust can still be used to pay the spouse at home’s allowance.

Joint income

Income from jointly owned assets, such as interest from a joint savings account or rent from jointly owned property, is generally split evenly between the spouses. If there are records showing a different ownership split, the state may follow them.

Couples sometimes change how income-producing assets are titled after approval, for example moving a joint account into the spouse at home’s name so the interest is theirs. This should be done carefully, because it can affect the applicant’s patient liability and the spouse’s allowance.

When the spouse at home’s income is high

If the spouse at home’s own income is above their MMMNA, no part of the applicant’s income is moved to them. Their income still stays theirs; they are not asked to contribute it. All of the applicant’s income, after the personal needs allowance and health insurance premiums, goes toward care.

Raising the income allowance

The MMMNA can be raised above the standard in two ways:

Fair hearing: if there are “exceptional circumstances resulting in significant financial duress,” such as large medical bills for the spouse at home.
Court order: a court order of support for the spouse at home.

A higher allowance can also justify letting the spouse at home keep more assets, if those assets are needed to produce income. See Raising the allowances through a fair hearing.

When both spouses need care

If both spouses are in a nursing home, there is generally no spouse at home to protect. Each spouse’s income goes toward their own care after their own personal needs allowance. See When both spouses need care.

Home care waivers

For a married person getting care at home through a waiver, the spousal income rules generally apply as they do for nursing home care. The applicant may keep a larger personal allowance for living costs, and the spouse at home’s allowance is figured similarly. Rules vary by state.

Records to gather

Gross income statements for both spouses (Social Security award letters, pension statements).
The spouse at home’s housing costs: mortgage or rent, property tax, homeowners insurance, condo fees.
Information on any dependents living with the spouse at home.
Statements for joint accounts and other income-producing assets.

Why getting this right matters

The income allowance can be worth thousands of dollars a year to the spouse at home. Missing the housing adjustment, failing to set up the monthly transfer, or overlooking a fair hearing option can cost the spouse at home money they were entitled to. Couples are encouraged to work with a Certified Medicaid Planner (CMP) to make sure the spouse at home’s income is protected.

Common questions

Will Medicaid take my income if my spouse goes into a nursing home? No. Your own income stays yours.

Can I receive part of my spouse’s income? Yes, if your income is below your MMMNA.

Does the allowance happen automatically? The state figures it, but the money must actually be paid to the spouse at home each month.

A year in the life of the allowance

The income allowance is not set once and forgotten. It can change:

in January, when Social Security increases change both spouses’ incomes and the MMMNA maximum rises;
in July, when the federal minimum MMMNA changes ($2,705 from July 1, 2026);
when housing costs change, such as a property tax increase or a new insurance premium;
at renewal, when the state reviews both spouses’ income;
when either spouse’s income changes for another reason.

Each change can raise or lower the amount moved to the spouse at home. Families should keep the state informed and check each new notice.

Common mistakes

Not transferring the allowance. If the money is not actually paid to the spouse at home, it may be counted toward the nursing home bill.
Leaving out housing costs. Missing the excess shelter allowance can cost the spouse at home hundreds of dollars a month.
Counting net instead of gross income. Using take-home figures can make the allowance look larger or smaller than it should be.
Not asking for a hearing. When medical bills or other hardships are high, a fair hearing can raise the allowance.

Income for couples in income cap states

In states with a $2,982 cap, the cap applies only to the applicant spouse. If the applicant’s income is over the cap and a Qualified Income Trust is used, the trust can still pay the spouse at home’s allowance. Setting up the trust correctly, and making the deposits every month, protects both the applicant’s eligibility and the spouse’s income. See Qualified income (Miller) trusts.

Questions couples often ask

Is the at-home spouse’s income counted for the applicant’s eligibility? In most states, only the applicant’s income counts toward eligibility. The at-home spouse’s income is used mainly to decide whether an income allowance is needed.

What if the at-home spouse has more income than the applicant? Then there may be no spousal income allowance, but the at-home spouse keeps their own income.

Can the allowance be raised? Yes, through a fair hearing, in some cases where exceptional circumstances cause significant financial hardship. A Certified Medicaid Planner (CMP) can review whether it applies.

Does the allowance continue if the at-home spouse’s income rises? The allowance is recalculated when income changes, so report changes on time.

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