Medicaid has rules that govern both the assets and the income of recipients.

Assets

If a Medicaid recipient lives in a nursing home and has a spouse, there are special rules. This is so the spouse who does not live in the nursing home can have enough money to pay for their own expenses.

The Medicaid recipient in the nursing home can keep non-exempt assets totaling $2,000. The spouse who continues to live in the community can keep non-exempt assets, up to $129,084, as of January 1, 2024. This is called the Community Spouse Resource Allowance (CSRA).

The spouse in the nursing home may transfer assets to the community spouse.

Example: Sam lives in a nursing home. His wife, Mary, lives in their house. Sam's assets include a $40,000 Certificate of Deposit. Mary's assets include a $20,000 savings account. Sam and Mary also own a joint savings account with a balance of $10,000. Because Mary's assets are below the CSRA, Sam may transfer his assets to Mary up to the amount of the CSRA. In this case, Sam may transfer all of his assets to Mary, because the total value of the combined assets ($70,000) is less than the CSRA of $129,084.

Income

For Medicaid recipients living in nursing homes, there are special rules regarding income. The spouse in the nursing home may keep income of only $30 per month (or $90 if they get veteran’s benefits). If the spouse in the community (i.e. "community spouse") has an income below $3,853.50, the nursing home spouse may transfer income to them up to that limit. This is called the Community Spouse Maintenance Needs Allowance (CSMNA). 

Example: Sam lives in a nursing home. His wife, Mary, lives in their house. Sam's monthly income is Social Security of $900 and a pension of $200. Mary's monthly income is Social Security in the amount of $500. Because Mary's income is below the CSMNA of $3,853.50, Sam may transfer his income to Mary, up to that amount. In this case, Sam may transfer all of his income to Mary, because the total value of the combined monthly income ($1,600) is less than the CSMNA.