THE SHORT ANSWER

When one spouse needs long-term care and the other stays home, New York Medicaid lets the spouse at home keep the house, a car, their own income, and a share of the couple's savings — in 2026, between $74,820 and $162,660. If the at-home spouse's income is low, part of the other spouse's income can go to them, up to a protected $4,066.50 per month.

The fear we hear most from husbands and wives is some version of: "If my spouse goes on Medicaid, will I lose everything?" In New York, the answer is no. The law has specific protections for the spouse who stays home.

Who's who

  • The applicant (sometimes called the institutionalized spouse) is the one who needs care.
  • The community spouse is the one staying at home.

These protections apply when the applicant needs nursing home care, and in many cases when they need Medicaid home care.

What the spouse at home keeps

Protection 2026 amount
Savings the spouse at home can keep $74,820 to $162,660
Savings the applicant can keep $33,038
Protected monthly income for the spouse at home $4,066.50 per month

The house. Exempt while the spouse lives there, subject to a home-equity limit of $1,130,000 in 2026.

One car, household goods, and personal belongings.

Their own income — Social Security, pension, wages. None of it is counted toward the applicant's eligibility.

How the savings allowance works

New York looks at all countable assets the couple owns together or separately, as of the date care begins. The spouse at home can keep an amount between the state minimum and federal maximum shown above. The applicant keeps their own smaller allowance. What remains is generally what must be spent down or planned for before Medicaid pays.

How the income allowance works

If the spouse at home's own income is below $4,066.50 per month, part of the applicant's income can be redirected to them to make up the difference. This is called the spousal income allowance. In some cases, higher housing costs can raise it further.

Whatever income the applicant has left, after the spousal allowance, a personal needs allowance of $50 per month (in a nursing home), and health insurance premiums, goes toward the cost of care.

Spousal refusal: what it is

New York allows a community spouse to formally decline to contribute their resources — known as spousal refusal. It's legal, but it's not free of consequences: the county may seek support from the refusing spouse. It's a decision to make only with an elder law attorney. What spousal refusal is.

Questions families ask

Does the spouse at home have to spend down to $33,038?

No. That limit applies to the spouse who needs care. The spouse at home can keep a separate, much larger allowance.

Is the at-home spouse's income counted?

No. Only the applicant's income is counted. The at-home spouse keeps their own Social Security, pension, and wages.

Can the at-home spouse keep the house?

Yes. The home is generally exempt while a spouse lives there, and it can usually be transferred to the at-home spouse without a penalty.

What is spousal refusal?

A New York procedure in which the at-home spouse declines to make their resources available. It is legal but has consequences, including possible collection efforts. Discuss it only with an elder law attorney.

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