When Both Spouses Need Care

The spousal impoverishment rules are built for one situation: one spouse needs long-term care and the other stays at home. When both spouses need nursing home care, or both need care at home through a waiver, those protections usually no longer fit. This guide explains how Long-Term Care Medicaid generally treats couples when both need care.

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

Why the usual spousal rules may not apply

The CSRA and MMMNA exist to protect a community spouse: a spouse living at home who does not need long-term care. If both spouses are in a nursing home, there is no community spouse to protect. In that case:

there is generally no CSRA (no assets set aside for a spouse at home);
there is generally no MMMNA (no income redirected to a spouse at home);
each spouse must meet the asset and income rules on their own, or as a couple, depending on the situation and state.

Asset limits when both spouses apply

The asset limit depends on the state and on how the couple is treated.

Situation	Typical 2026 asset limit
Both spouses apply together as a couple, in a state where the single limit is $2,000	$3,000 for the couple
Pennsylvania	$2,400 per spouse
States with a different single limit	The state’s own couple figure. See your state guide
Each spouse treated as an individual (common once both have been in a nursing home for a while)	Each spouse’s own single limit

Examples from the state guides:

Florida: $2,000 for a single applicant, $3,000 for a couple who both apply.
New York: $33,038 for a single person and $44,796 for a couple in 2026.
California: $130,000 for one person and $195,000 for a couple in 2026.

When each spouse is treated separately

Federal rules for people in institutions say that, starting with the month after the month a couple stops living together, each spouse is generally treated as an individual. When both spouses are in nursing homes, many states treat them as two individuals:

Each spouse must have assets at or below the single limit.
Jointly owned assets are usually split between them (often half each, unless records show otherwise).
Each spouse’s own income goes toward their own care.

If both spouses are in the same room or same facility, some states still treat them as a couple for the month they move in, then as individuals. The details vary.

Income when both need care

Each spouse’s income generally goes toward his or her own cost of care, after:

each spouse’s own personal needs allowance (for example, $160 a month each in Florida);
health insurance premiums and certain medical costs.

Because there is no spouse at home, no income is redirected to a spouse.

Income limits. In states with an income cap (for example, $2,982 a month for an individual in 2026 in many states, which is 300 percent of the federal SSI benefit), each spouse’s income is usually measured on its own. A spouse over the cap may need a Qualified Income (Miller) Trust.

The home when both spouses are in care

When one spouse is at home, the home is exempt. When both are in care, the home’s status depends on:

Intent to return. Many states keep the home exempt if either spouse intends to return home, even if a return is unlikely. See Intent to return home.
A dependent relative living there. The home can stay exempt if certain relatives live in it.
Home equity limit. If no spouse lives at home, the home equity limit applies. In 2026 it is $752,000 in most states, and up to $1,130,000 in states that choose the higher limit.

If the home stops being exempt, it may be counted as an asset, and families often think about selling it. See Selling the home. Estate recovery may also apply later. See Estate recovery.

When one spouse needs care first, then the other

A common situation: one spouse enters a nursing home and is approved using the spousal rules. A year or two later, the spouse at home also needs care.

When the first spouse was approved, the spouse at home kept assets under the CSRA. Those assets are usually in the spouse at home’s name by now.
When the second spouse applies, those assets are generally counted for that spouse. The second spouse must get down to the single limit.
There is usually no second CSRA, because there is no longer a spouse at home to protect.
The look-back applies to the second spouse’s application, so gifts made by either spouse in the past 60 months can be reviewed.

Example

Joe entered a nursing home in Georgia in 2025 and was approved. His wife Ann kept $120,000 under the CSRA, in her own name. In 2026 Ann also needs nursing home care. When Ann applies, her $120,000 counts for her. She must spend down to Georgia’s single limit before Medicaid pays for her care. Money she spends on her own care, debts, a prepaid funeral plan or other allowed costs is not a gift.

Both spouses on home care waivers

When both spouses need care at home through a waiver:

Many states treat them as a couple for assets, so the couple limit applies.
Income rules vary. Some states look at each spouse’s income separately; others look at the couple’s combined income.
Waiver programs often have waiting lists. Each spouse may need to qualify and get a slot.

See your state guide for waiver programs.

One spouse at home, one in care, then roles change

If the spouse who was at home now needs care, but the first spouse has died, the surviving spouse is simply an individual applicant. If the first spouse is still living, see “When one spouse needs care first, then the other,” above.

Practical points for families

Apply for each spouse. Each spouse who needs Long-Term Care Medicaid must be found eligible.
Keep the couple’s records together. The state will usually ask for 60 months of statements for both spouses.
Plan for two personal needs allowances, not one income for a spouse at home.
Consider experienced help. When both spouses need care, a Certified Medicaid Planner (CMP) can help with the timing of each application.
Watch the home. Once no spouse lives there, the rules on home equity, intent to return, and estate recovery all become more important.

Common questions

Can we keep one bank account together? Usually yes, but the state will look at whose money is in it. Joint accounts are often split equally between the spouses when each is treated as an individual.

What if one spouse dies? The surviving spouse is then an individual applicant. Any assets inherited from the spouse who died count for the survivor, unless they are exempt. A new look-back review may apply if the survivor is applying for the first time.

Do both spouses need to apply at the same time? No. Each spouse applies when they need care. The timing affects which rules apply, as explained above.

Are personal needs allowances combined? No. Each spouse in a nursing home gets their own personal needs allowance.

What about a couple where one spouse is in a nursing home and the other uses a home care waiver? In that case, the spouse on the waiver is not a “community spouse” in the usual sense under many states’ rules, because both are receiving long-term care. States handle this situation differently. See your state guide.

Comparing the two situations

	One spouse in care, one at home	Both spouses in care
Assets set aside for a spouse	CSRA: $32,532 to $162,660 in 2026	Generally none
Income for a spouse	MMMNA: $2,705 to $4,066.50 a month (from July 1, 2026)	Generally none
Asset limit	Applicant’s single limit, after the CSRA	Couple limit (for example, $3,000 where the single limit is $2,000; $2,400 per spouse in Pennsylvania), or each spouse’s single limit
The home	Exempt while the spouse lives there	Depends on intent to return and the home equity limit
Personal needs allowance	One, for the spouse in care	One for each spouse

The move from the first column to the second is often the hardest financial moment for a family. Assets that were protected for the spouse at home may now need to be spent on that spouse’s care. Knowing this ahead of time helps families plan for it.

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