Paying for Senior Care When One Spouse Moves
Oasis Senior Advisors
For more information about the author, click to view their website: Oasis Senior Advisors of Salt Lake City
Sep 10, 2026
Utah - Utah
Few transitions in life feel as difficult as the moment when
one spouse needs to move to a care community while the other remains at home.
Perhaps one partner is living with advanced dementia and needs the security of
memory care, while the other is still active and independent. Or maybe a stroke
or chronic illness has created care needs that can no longer be safely managed
at home, despite the spouse’s best efforts.
These situations bring a complicated mix of emotions,
including grief over changing roles, worry about separation, and uncertainty
about the future. Layered on top of these feelings is a pressing financial
concern: How do we approach funding senior care without leaving the spouse who
lives at home unable to afford basic living expenses?
The good news is that financial protections exist
specifically to address this scenario, particularly when Medicaid is involved.
Understanding how income and assets are evaluated when only one spouse needs
care, and knowing which funding options may be available, can provide both
practical direction and much-needed peace of mind during an already stressful
time.
Medicaid rules that protect the spouse at home
When one spouse needs to move to a nursing home or, in some states, to assisted
living through a Medicaid waiver program, special rules help protect the
financial security of the spouse who remains at home (referred to as staying in
the community, meaning their local community as opposed to a senior living
community). In Medicaid terminology, this person is called the “community
spouse,” while the person entering care is the “institutionalized spouse.”
What care settings do these protections apply to? Community
spouse protections primarily apply when one spouse enters a nursing home and
needs Medicaid to help pay for that care. In states that offer Medicaid waiver
programs covering assisted living or memory care, some of these protections may
also apply, though the rules can differ. These protections generally do not
apply to independent living or other residential settings that don’t qualify
for Medicaid long-term care coverage.
The core principle behind these protections is preventing
“spousal impoverishment,” the idea that paying for one spouse’s care shouldn’t
leave the other spouse destitute. Without these rules, couples would need to
spend nearly all their joint savings before Medicaid would help, potentially
leaving the community spouse with almost nothing to live on.
Instead, Medicaid’s spousal impoverishment protections allow
the community spouse to keep a protected amount of the couple’s joint assets
and income. Two key terms define these protections:
- The Community Spouse Resource Allowance (CSRA) is the
amount of the couple’s combined countable assets that the community spouse
can retain without affecting the institutionalized spouse’s Medicaid
eligibility. For 2025, federal guidelines set this range between
approximately $31,584 (the minimum) and $157,920 (the maximum),
though the exact amount varies by state. Some states automatically allow
the maximum, while others calculate it based on half of the couple’s
combined countable assets, up to that maximum.
- The Minimum Monthly Maintenance Needs Allowance (MMMNA) protects
the community spouse’s income. If the community spouse’s own income falls
below a certain threshold (approximately $2,644 to $3,948 per month, depending on the state),
they may be entitled to some or all of their institutionalized spouse’s
income to reach that minimum level. This ensures that the community spouse
has an adequate monthly income to maintain their household.
These protections make a significant practical difference.
Instead of spending down to near-poverty levels, a couple can preserve
substantial resources for the community spouse’s ongoing living expenses, home
maintenance, and future needs, while still qualifying the institutionalized
spouse for Medicaid coverage. These rules are central to funding senior care in
a way that safeguards both partners’ needs.
Paying for senior care: Funding and benefit options to
explore
Beyond Medicaid’s spousal protections, several funding
sources may help cover care costs when one spouse moves to a community. Most
families use a combination of these options over time and understanding them is
an important part of funding senior care responsibly and sustainably.
Private savings or retirement income
Many couples initially pay for care using savings,
retirement accounts, Social Security benefits, and pensions. When both spouses
have their own income streams, families can often dedicate one spouse’s income
toward care costs while the other spouse’s income covers household expenses at
home.
This arrangement can work well in the short term, though it
may not be sustainable indefinitely if care costs significantly exceed one
spouse’s income. For example, if assisted living costs $5,000 monthly but the
spouse needing care receives only $2,500 in Social Security benefits, the
couple must cover the $2,500 gap from savings or other income, a strategy that
works until their savings deplete to levels where Medicaid eligibility becomes
relevant.
Veterans benefits (Aid and Attendance)
The VA’s Aid and Attendance benefit can provide additional
monthly income to help pay for care, and it applies in situations where one
spouse needs care while the other remains at home. This benefit is available to
qualifying wartime Veterans or their surviving spouses who need help with daily
activities.
Importantly, when one spouse is a Veteran and the other
needs care, the Veteran may claim Aid and Attendance benefits on behalf of
their spouse. Similarly, if the Veteran needs care and has a spouse at home,
the benefit amount may be higher than for a single Veteran, recognizing the
need to support both the Veteran and the dependent spouse.
This benefit considers household income and medical
expenses, so families paying significant care costs may qualify even with
moderate retirement income.
Long-term care insurance
If one or both spouses purchased long-term care insurance years ago, this can be a
significant help. These policies typically pay a daily or monthly benefit when
the insured person needs assistance with activities of daily living, regardless
of the care setting, whether in a nursing home, assisted living, memory care,
or even at home.
When only one spouse has a policy, that insurance covers
their care costs, preserving more of the couple’s joint assets and income for
the community spouse’s needs. Some policies also include inflation protection
or shared benefits between spouses, which can extend coverage considerably.
Medicaid
For many couples, Medicaid eventually becomes necessary when care costs
exhaust other resources. When one spouse applies for Medicaid, eligibility is
determined using special rules that account for the couple’s marital status.
Rather than treating each spouse’s income and assets
separately, Medicaid looks at the couple’s combined resources, then applies the
community spouse protections described earlier. This means the community spouse
can retain protected amounts of both assets and income, while the
institutionalized spouse can qualify for Medicaid even though the household as
a whole has resources above the typical individual eligibility limits.
The application process requires substantial documentation,
financial records, asset statements, proof of income, and medical evaluations,
and the rules around asset transfers and look-back periods are complex.
However, the protections built into the system specifically for married couples
can make Medicaid a viable option for funding senior care without impoverishing
the spouse who remains at home.
Where to find reliable help
Navigating these financial decisions while managing the
emotional challenges of separation and changing care needs can feel
overwhelming. You don’t have to figure it all out alone.
Contact your local Oasis advisor. Senior care advisors understand
the local care landscape and can help you identify communities that fit both
your loved one’s care needs and your family’s financial situation. They can
explain which communities work with different payment sources, including
Medicaid, and guide you through the process of finding appropriate care. Find your
local Oasis advisor to get personalized support during this
transition.
Consult an elder law attorney. If Medicaid eligibility is a concern,
either now or in the foreseeable future, working with an elder law attorney who
specializes in Medicaid planning is invaluable. These attorneys understand your
state’s specific rules, can help you navigate community spouse protections,
ensure you’re maximizing allowable asset retention, and guide you through the
application process to avoid costly mistakes.
The situation you’re facing is difficult, but resources and protections exist to help you secure necessary care for one spouse while preserving financial stability for the other. With the right information and support, you can make decisions that honor both partners’ needs during this challenging chapter.
- To view the original version of this article visit www.oasissenioradvisors.com/blog/paying-for-senior-care-when-one-spouse-moves/
- Seniors Blue Book was not involved in the creation of this content.
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