Please ensure Javascript is enabled for purposes of website accessibility

Protecting the Healthy Spouse

Posted on

Spousal impoverishment is a concern for older couples when one spouse needs long-term care and applies for Medicaid. If one spouse requires care in a skilled nursing facility and the other remains at home, the spouse at home might face significant financial hardships. The high costs of nursing homes combined with Medicaid’s strict income and asset requirements risk leaving the community spouse destitute.

Medicaid’s Spousal Impoverishment Rules

Before the federal government enacted spousal impoverishment protections in 1988, many healthy spouses experienced poverty when their partners went on Medicaid.

Before receiving Medicaid, many families had to spend down their assets, leaving few assets for the spouse at home. Prior to qualifying for Medicaid, many couples paid nursing home fees out-of-pocket. Only when they could no longer pay would government assistance become available. Once all their funds went to long-term care expenses, the spouse living at home had little support.

Medicaid’s 1988 spousal impoverishment provisions responded to these concerns, protecting spouses from loss of money and resources when their partners require long-term care. The spousal impoverishment rules rest on the principle that both spouses have a duty to provide for each other. Although the spouse at home must support the spouse receiving long-term care, the spouse receiving care also has a responsibility to the community spouse. The regulations allow the community spouse to keep a certain proportion of the couple’s combined resources and income, preventing impoverishment.


Per the spousal impoverishment rules, the Minimum Monthly Maintenance Needs Allowance (MMNA) and Community Spouse Resource Allowance (CSRA) permit the healthy spouse to keep a portion of the couple’s assets and income.

  • The MMNA is to ensure the healthy spouse living in the community has sufficient monthly income for their support.  The rules permit the income of an institutionalized spouse to be shifted to the community spouse in the event the community spouse’s income is below the MMNA.
  • The CSRA protects some of the couple’s assets for the community spouse. The federal government determines the minimum and maximum Community Spouse Resource Allowance yearly. Some assets, such as the couple’s home, car, furnishings and appliances, and personal possessions, do not count toward Medicaid’s asset threshold.

If you would like to discuss Medicaid Planning and options to protect your estate from the costs of long term care, call 570-784-4654 to schedule an appointment with one of our Certified Medicaid Planners.

Get in touch with us today to get started with your FREE case review. We’re only a call, click, or short drive away.