One of the most frightening scenarios in retirement is this: one spouse enters a nursing home, and the other spouse watches the couple's lifetime savings drain away paying for care — until almost nothing is left. Federal law prevents the worst version of this scenario. The Medicaid spousal impoverishment rules — formally called the "Community Spouse Resource Allowance" (CSRA) and the "Minimum Monthly Maintenance Needs Allowance" (MMMNA) — establish floors below which the at-home spouse's financial situation cannot be forced by the Medicaid spend-down process.
When one spouse (the applicant spouse) applies for Medicaid nursing home benefits, the program does not demand that the couple spend down to zero. It assesses their combined countable assets and establishes how much the at-home spouse — called the community spouse — can keep. There are two separate protections: — a one-time asset protection at the time of application. The Community Spouse Resource Allowance (CSRA) — an ongoing income protection throughout the period of care. The Minimum Monthly Maintenance Needs Allowance (MMMNA)
The CSRA determines how much of the couple's combined countable assets the community spouse is permitted to keep when the applicant spouse qualifies for Medicaid. The general rule: the community spouse keeps half of the couple's combined countable assets, subject to a federal minimum and maximum. In 2026, those limits are:
Limit 2026 Amount When It Applies Minimum CSRA $32,532 Community spouse keeps the full amount if total assets are below $32,532 Maximum CSRA $162,660 Half-and-half calculation is capped here; amounts above require spend-down or additional planning Source: Medicaid.gov — January 2026 SSI and Spousal CIB; medicaidplanningassistance.org — 2026 Eligibility Criteria How the math works with two examples: Example A — $200,000 combined assets: The community spouse keeps $100,000 (half). The applicant spouse is limited to $2,000. The remaining $98,000 must be spent down or protected through other planning. Example B — $400,000 combined assets: Half would be $200,000, but the CSRA maximum is $162,660. The community spouse keeps $162,660. The applicant spouse keeps $2,000. The remaining $235,340 must be spent down or protected through planning. Note that "countable assets" excludes certain categories — the primary home (under the equity cap), one vehicle, household furnishings, irrevocable prepaid funeral plans, and term life insurance. The CSRA calculation applies only to countable assets, so the actual protection available is often greater than the CSRA figures alone suggest.
The MMMNA addresses income, not assets. It guarantees that the community spouse has a minimum monthly income regardless of how much of the couple's income is being directed toward nursing home costs. Here is how it works: when one spouse enters a nursing home, most of their income — Social Security, pension, investment distributions — must go toward paying the nursing home as "patient liability." This can leave the community spouse with very little monthly income. The MMMNA establishes a floor. If the community spouse's own income falls below that floor, they can claim a portion of the institutionalized spouse's income to bring their monthly total up to the minimum. In 2026:
An elder law attorney can calculate your state-specific CSRA, review
Medicaid.gov — January 2026 SSI and Spousal CIB;|Medicaid.gov — January 2026 SSI and Spousal CIB; Elder Law