If My Husband Goes Into a Nursing Home, Who Pays?

If your husband goes into a nursing home, who pays depends on where you are in a sequence: your joint savings and any long-term care insurance come first, Medicare may cover a short skilled-nursing stay after a qualifying hospital admission, and Medicaid takes over once his countable assets are spent down. Federal spousal impoverishment rules let you, as the spouse still at home, keep a share of the couple’s assets and income and stay in your house. The order matters, because each source has its own rules about what it covers and what it leaves for the next payer.

What a Nursing Home Actually Costs

A semi-private room runs around $9,800 per month at the national median in 2026, and a private room pushes past $11,000. That’s roughly $118,000 to $136,000 a year, before any regional adjustment. Costs vary by area and keep climbing with inflation.

Most families begin by paying out of pocket from savings, retirement accounts, and investments. At these rates, even a substantial nest egg can be gone in two to four years. That pressure is what pushes most families toward Medicaid, the program actually designed to cover long-term custodial care.

Why Medicare Won’t Carry This

Medicare is not a long-term care program, and this trips up a lot of families. It covers a skilled nursing facility stay only on a short-term basis, and only after your husband has been admitted as a hospital inpatient for at least three consecutive days.¹

Even when he qualifies, the window is narrow. Medicare pays in full for the first 20 days after the Part A deductible, requires a daily copayment from days 21 through 100, and stops entirely after day 100.¹ It does not cover the ongoing custodial care most nursing home residents need: help with bathing, dressing, eating, moving around. That’s Medicaid’s job.

Long-Term Care Insurance If You Have It

If your husband bought a long-term care insurance policy before he needed care, it can cover some or all of the daily nursing home cost for a set benefit period. These policies have to be purchased well in advance, while the applicant is still healthy enough to be underwritten, so this is not something you can arrange now if it wasn’t done years ago. If a policy is in place, it can delay or prevent the spend-down to Medicaid. Some states run Long-Term Care Partnership programs that let policyholders protect additional assets from Medicaid’s asset test, dollar for dollar, based on what the policy paid.

How Medicaid Pays Once Savings Run Down

Medicaid is a joint federal-state program. The federal government sets the framework; each state fills in income limits, application procedures, and how much a spouse at home can keep. Unlike Medicare, Medicaid is built to cover ongoing custodial care for as long as a resident needs it.

The rules treat you and your husband as two different people with two different sets of limits. He is the “institutionalized spouse,” and you are the “community spouse.” The eligibility caps apply to him. A separate set of protections applies to you.

The Asset Test

To qualify for Medicaid-funded nursing home care, your husband’s countable assets generally must fall below $2,000 in most states.² That number sounds impossible until you see what doesn’t count.

Countable assets include bank accounts, stocks, bonds, CDs, and real estate other than the home you live in. Excluded from the calculation:

Your primary residence, as long as you continue to live there.³
One vehicle, typically regardless of value.
Personal belongings and household goods.
Prepaid funeral and burial plans, up to state limits.

The home exemption has a catch worth knowing. If your husband’s equity interest in the home exceeds a threshold set by your state, he can be denied Medicaid coverage for nursing facility services even while you’re still living there. Federal law sets a floor of $752,000 and a ceiling of $1,130,000 for 2026, and most states use the lower figure.⁴ Equity is market value minus mortgage balance. Paying down a mortgage can actually push you closer to the limit, so get advice before making large payments.

The Income Test

Medicaid also looks at your husband’s monthly income from every source: Social Security, pension, investment returns. Nearly all of it has to go toward the nursing home bill. He keeps only a small personal needs allowance, which starts at a federal minimum of $30 per month and runs higher in some states, plus what he needs for health insurance premiums.² The nationwide average is around $70 per month.

Income eligibility works differently depending on where you live. Most states use an income cap, which for 2026 is $2,982 per month.⁵ If his income exceeds that, he’s not automatically disqualified, but he’ll need a qualified income trust (sometimes called a Miller Trust) to route the excess. The remaining states use a “medically needy” pathway that lets applicants spend excess income on medical bills until they meet the state’s limit. Both routes have real paperwork and are worth setting up with an attorney rather than trying alone.

What You Get to Keep as the Spouse at Home

Federal spousal impoverishment rules exist so that his nursing home costs don’t strip you of everything. These rules carve out a share of the couple’s combined assets and income that belongs to you, free from any claim by the facility.

The Community Spouse Resource Allowance

The Community Spouse Resource Allowance (CSRA) is the portion of your combined countable assets you get to keep. For 2026, the federal minimum is $32,532 and the federal maximum is $162,660.⁵ Each state picks a figure inside that range. Some use the maximum, some use the minimum, and others calculate a “spousal share” equal to half the couple’s combined countable assets, capped at the federal maximum. Finding out which approach your state takes is one of the first things to nail down.

Monthly Income for You

The Minimum Monthly Maintenance Needs Allowance (MMMNA) sets a floor for how much monthly income you’re guaranteed. If your own income falls below that floor, you’re entitled to receive part of your husband’s income to bring you up to it.⁶ The federal minimum is $2,643.75 per month and the federal maximum is $3,948 per month. The minimum adjusts each July, the maximum each January, and your state sets the actual amount within that range.

Housing costs can push your allowance higher. If your rent or mortgage, taxes, insurance, and utilities exceed a standard amount, the excess is added to your MMMNA through what’s called an excess shelter allowance. Spouses in high-cost areas often qualify for a larger income allocation this way, up to the federal maximum.

Your Home

Your home is protected from Medicaid’s asset calculation as long as you continue to live in it.³ You cannot be forced to sell it to pay for your husband’s care, and the state cannot place a lien on it while you’re living there.⁷ The same protection extends to a child under 21 or a blind or disabled child of any age living in the home. As a practical matter, if his equity is under the state’s threshold and you’re living there, the home is safe during his lifetime.

The Five-Year Look-Back

Medicaid doesn’t just look at what you own the day you apply. Federal law requires a review of every financial transaction either of you made during the 60 months before the application.⁴ The point is to catch transfers made for less than fair market value: gifts to children, property sold at a discount, money moved into someone else’s name.

When a disqualifying transfer turns up, Medicaid doesn’t fine you. It calculates a period of ineligibility by dividing the total value of the improper transfers by the average monthly cost of nursing home care in your state.⁴ If your state’s average is $10,000 and the flagged transfers total $80,000, that’s eight months of ineligibility.

Here is the part that hurts. The penalty period doesn’t start when the transfer happened. It starts when your husband would otherwise be eligible, meaning he is already in the facility and his assets are already down to the limit. During those penalty months, someone has to pay the nursing home out of pocket without any Medicaid help. This is the gap that catches families who moved money around without professional advice. Transfers directly between spouses are not penalized, so shifting assets into your name is not the trap; informal gifting to adult children usually is.

What Happens After He Dies: Estate Recovery

Medicaid’s involvement doesn’t necessarily end with his death. Federal law requires every state to seek reimbursement from the estates of Medicaid beneficiaries who were 55 or older when they received long-term care benefits.⁴ Some states go further and recover for all Medicaid services, not just long-term care.

The key protection for you: no estate recovery can happen while you are alive. The state has to wait until after the surviving spouse has died to pursue anything.⁷ The same shield applies if he is survived by a child under 21 or a blind or disabled child. The family home is safe from Medicaid’s claim as long as you live there.

After both of you are gone, the state can pursue the estate for reimbursement, including the value of the home. States must offer an undue hardship waiver where recovery would cause serious financial harm to heirs, for example a family farm or business someone depends on for a living. If estate recovery is a concern, planning with an attorney ahead of time can shape what the state ultimately reaches.

VA Aid and Attendance

If your husband is a wartime veteran, the VA’s Aid and Attendance pension can add monthly income toward the nursing home. It’s separate from Medicaid and can be received alongside it.

For 2026, the maximum annual pension for a veteran with a dependent spouse who qualifies for Aid and Attendance is $34,488, or roughly $2,874 per month; for a veteran with no dependents, it’s $29,093 a year, about $2,424 per month.⁸ Surviving spouses who qualify can receive up to $18,697 per year with no dependents, or $22,304 with one dependent child.⁹

Eligibility requires that his net worth, counting both assets and annual income, fall below $163,699 for the period from December 2025 through November 2026.⁸ Like Medicaid, the VA excludes the primary residence and one vehicle. The VA also has its own three-year look-back for asset transfers, so the same caution about giving things away applies here.

When to Bring in an Elder Law Attorney

Medicaid planning is one area where professional guidance pays for itself. An elder law attorney can help with asset protection, setting up a qualified income trust if his income exceeds the cap, running the application, and steering you around look-back violations that create coverage gaps. Hourly rates typically run from $195 to $500 depending on location, and some pieces of work, like a trust or the application itself, are handled for a flat fee. The Medicaid application ordinarily takes 30 to 90 days to process, and missing documentation can add months while the nursing home bill continues to grow.

The earlier you start, the more options you have. The five-year look-back means the strongest asset protection strategies only work if they’re in place well before nursing home admission is on the table. If his health is declining and you haven’t started, talk to an attorney before transferring anything or making large financial changes on your own.

1
Medicare.gov. Skilled Nursing Facility Care
2
Department of Health and Human Services, Office of the Assistant Secretary for Policy and Evaluation. Spouses of Medicaid Long-Term Care Recipients
3
U.S. Department of Health and Human Services ASPE. Medicaid Treatment of the Home: Determining Eligibility and Repayment for Long-Term Care
4
Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets
5
Centers for Medicare and Medicaid Services. 2026 SSI and Spousal Impoverishment Standards
6
Centers for Medicare and Medicaid Services. Updated 2025 SSI and Spousal Impoverishment Standards
7
Medicaid.gov. Estate Recovery
8
U.S. Department of Veterans Affairs. Current Pension Rates for Veterans
9
U.S. Department of Veterans Affairs. Current Survivors Pension Benefit Rates