How Much Can a Spouse Keep When Applying for Medicaid? The CSRA Math, Worked Out

A husband with early dementia needs nursing home care. His wife is healthy and lives at home. The couple has about $260,000 in savings plus the house, and the wife has been told — by a neighbor, a Facebook group, the facility’s intake desk — that they’ll have to spend nearly all of it before Medicaid pays. So how much can a spouse keep when applying for Medicaid on the other’s behalf? That advice she got is wrong, and the gap between it and the actual rule is often six figures.

When one spouse needs nursing home Medicaid and the other doesn’t, federal spousal impoverishment rules let the at-home spouse — the “community spouse” — keep a substantial share of the couple’s assets and a floor of monthly income. Here is how the asset number is actually calculated, with real figures.

How much can a spouse keep? Start with the CSRA

The core protection is the Community Spouse Resource Allowance (CSRA) — the amount of countable assets the community spouse keeps when the other spouse applies for nursing home Medicaid. For 2026 the federal range is a minimum of $32,532 and a maximum of $162,660. Most states let the community spouse keep half of the couple’s combined countable assets, up to that maximum, with the minimum as a floor.

Two more pieces sit alongside it. The home is generally exempt while the community spouse lives there (below the state equity cap, $752,000 minimum in 2026), as is one vehicle. And income is handled separately from assets through a monthly allowance — covered further down.

Working the math: a real example

Take the couple above. The first step is the snapshot date — the date the ill spouse begins a continuous institutional stay (a 30-plus-day nursing home or hospital-to-nursing-home stay). Medicaid totals all countable assets owned by either spouse on that date. Say the snapshot total is $260,000.

In a typical 50%-up-to-maximum state, the calculation runs:

So the spend-down target is the applicant’s side — roughly $128,000 here — not the whole $260,000. In plain terms: the “you’ll lose everything” advice overstated the loss by about $130,000. That is the entire point of the rule, which Medicaid.gov frames as preventing the community spouse from being left impoverished by the other spouse’s care.

Two cases where the half-the-assets shortcut misleads

The 50% rule isn’t universal, and the edges are where families miscalculate. Run the same math at two different asset levels:

Sanity check: at $400,000 the cap binds; at $40,000 the floor binds; in the broad middle, half is the answer. Some states set higher minimums — Connecticut at $50,000, Washington around $72,529 — so the state-specific figure can be larger than the federal floor. State selection drives the result, the same way it drives the rest of Medicaid spend-down and asset limits by state.

Income is protected separately — the MMNA

Assets are only half the picture. If the community spouse’s own income falls below a floor, some of the institutionalized spouse’s income can be shifted to them through the Monthly Maintenance Needs Allowance (MMNA). For 2026 the federal range is $2,643.75 to $4,066.50 a month, with a housing allowance added when shelter costs run high.

This matters because the institutionalized spouse’s income normally goes to the nursing home as the patient-pay amount. The MMNA carves out enough of it first to keep the at-home spouse above the floor — so a wife whose only income is a small Social Security check isn’t left to live on it alone while her husband’s pension goes entirely to the facility.

What this changes about the plan

The takeaway isn’t a single number — it’s that “spend down to nothing” is the wrong mental model for a married couple. The community spouse keeps a real asset cushion (up to $162,660 in 2026), the home, a car, and an income floor. The spend-down applies to the applicant’s share, and even that can often be redirected into exempt or protective uses rather than simply consumed by care bills.

Two cautions before acting on this. First, executing any of it — spend-down, asset repositioning, applying on the ill spouse’s behalf — requires the right legal authority in place, which is why a Medicaid-capable power of attorney matters; see why a generic power of attorney won’t work for Medicaid planning. Second, gifting assets to “get under” the limit triggers the five-year look-back and a penalty period — the opposite of help. The community-spouse protections are generous enough that, for many couples, no risky maneuver is needed; the rule already keeps far more than they were told.