Medicaid Nursing Home Eligibility: Why Only the Institutionalized Spouse’s Income Counts

Under Medicaid’s “name on the check” rule, only the spouse entering a nursing home has their income counted for long-term care eligibility, while the other spouse’s income is excluded. Assets are treated differently: both spouses’ resources are pooled and must be spent down before qualifying. If the community spouse’s own income falls below the monthly maintenance allowance, some of the institutionalized spouse’s income can be redirected to them.

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Medicaid's long-term care eligibility separates a married couple's income by payment ownership. Federal spousal impoverishment protections, rooted in the Medicare Catastrophic Coverage Act, direct states to assign pension, IRA, and similar payments to the named recipient; jointly paid income is split. The spouse remaining at home therefore keeps their own earnings and benefits outside the nursing-home spouse's income test.

Resources follow a different path. Countable savings held by either spouse are combined for the resource test, including individual and joint accounts. The community spouse may retain a protected share, while the applicant may keep a state-set