Many married couples facing long-term care costs wonder: Can one spouse get Medicaid and the other not? The answer is yes, but eligibility depends on the type of Medicaid program, income, assets, and state-specific rules.
Federal protections are designed to prevent the healthy spouse from becoming financially vulnerable while the other receives care.
1. Can One Spouse Get Medicaid And The Other Not?
Yes, one spouse can qualify for Medicaid while the other does not. Medicaid eligibility is based on factors such as income, assets, age, disability status, and healthcare needs, so spouses are not always treated the same.
This situation commonly occurs when one spouse needs long-term care services, such as nursing home care or Medicaid home-based care, while the other spouse continues living at home.
In Medicaid terms, the spouse receiving long-term care is often called the institutionalized spouse, while the spouse remaining at home is known as the community spouse.
Special Medicaid rules may allow one spouse to receive benefits while helping protect certain income and assets for the spouse who remains at home.
2. How Medicaid Eligibility Works for Married Couples
If you are wondering can one spouse get Medicaid and the other not, the answer depends on the type of Medicaid program involved.
For many Medicaid programs that use Modified Adjusted Gross Income (MAGI) rules, eligibility is based largely on household income, which means both spouses’ income may be considered.
However, Medicaid programs that cover long-term care for older adults and people with disabilities often follow different rules.
In these cases, eligibility may be based primarily on the applicant’s income, assets, and care needs rather than the couple’s combined finances.
Special spousal protection rules can also help preserve income and assets for the spouse who remains at home. As a result, it is possible for one spouse to qualify for Medicaid while the other does not
>>> Read more: Average Cost of Assisted Living for a Couple: What to Expect in 2026
3. Medicaid Asset Rules for Married Couples
When determining eligibility for long-term care Medicaid, states generally review the couple’s combined assets.
However, special rules are designed to prevent the spouse who remains at home from becoming financially disadvantaged.
Countable vs Non-Countable Assets
Medicaid separates assets into two categories:
Countable assets may include:
- Cash and savings accounts
- Stocks and bonds
- Investment accounts
- Additional real estate
Non-countable assets may include:
- The primary home, if the community spouse lives there
- One vehicle in many states
- Personal belongings and household items
Community Spouse Resource Allowance (CSRA)
The Community Spouse Resource Allowance (CSRA) allows the spouse who remains at home to keep a portion of the couple’s assets while the other spouse applies for Medicaid long-term care coverage.
The exact amount varies by state and federal guidelines, but the purpose is to help protect the community spouse from financial hardship while preserving Medicaid eligibility for the applicant.
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4. Income Protection Rules (MMMNA Explained)
Many families asking can one spouse get Medicaid and the other not are concerned about how the spouse remaining at home will pay for everyday expenses.
To address this issue, Medicaid includes income protection rules for certain long-term care programs.
The Minimum Monthly Maintenance Needs Allowance (MMMNA) is a federal protection that helps prevent the community spouse from becoming financially impoverished.
If the spouse living at home has income below a state-established minimum level, Medicaid may allow a portion of the applicant spouse’s income to be transferred to them.
This additional income can help cover essential living expenses such as housing, utilities, and food.
MMMNA protections generally apply to certain long-term care Medicaid programs, including nursing home Medicaid, and the exact limits vary by state.
5. How To Apply For Medicaid Separately?
If one spouse needs Medicaid coverage while the other does not, the application process typically involves reviewing income, assets, and eligibility requirements for the applicant spouse.
- Step 1: Verify Eligibility Requirements
Review your state’s Medicaid rules for income, assets, and medical eligibility. Long-term care Medicaid programs often have different requirements than standard Medicaid coverage.
- Step 2: Gather Financial Information
Collect documents related to income, bank accounts, investments, property, and other assets. Medicaid may review both spouses’ financial information during the eligibility process.
- Step 3: Prepare Supporting Documents
You may need to provide identification, proof of income, medical records, and documentation showing ownership of assets and resources.
- Step 4: Submit the Application
Apply through your state’s Medicaid agency and indicate which spouse is seeking coverage. Make sure all required forms and supporting documents are included.
- Step 5: Respond to Follow-Up Requests
Medicaid caseworkers may request additional information before making a final eligibility determination. Responding promptly can help avoid delays.
>>> Read more: Medicaid Asset Protection Trust (MAPT): What It Is and How It Works in 2026
7. FAQs
Can a healthy spouse remain in the home if the other is on Medicaid?
Yes. Medicaid does not require a healthy spouse to leave the family home when the other spouse receives long-term care Medicaid. In most cases, the primary residence remains protected while the community spouse continues living there.
Will my spouse’s retirement income disqualify me?
Not necessarily. For long-term care Medicaid, eligibility is often based primarily on the applicant’s income and assets. Depending on the program and state rules, a spouse’s retirement income may not automatically disqualify the applicant.
Can we get divorced to qualify for Medicaid?
While some couples have considered divorce for Medicaid planning purposes, it is usually unnecessary. Modern Medicaid rules include spousal protections that help preserve income and assets for the spouse who remains at home.
Does my spouse’s income count as my income?
It depends on the Medicaid program. For many MAGI Medicaid programs, household income is counted. For certain long-term care Medicaid programs, eligibility may be based primarily on the applicant’s financial situation.
Final Words
Understanding can one spouse get Medicaid and the other not is essential when planning for long-term care and protecting family finances. Medicaid rules allow one spouse to qualify independently in many situations, particularly for nursing home care and home-based services.
Spousal impoverishment protections, asset allowances, and income safeguards help ensure the healthy spouse remains financially secure.
