Medicaid Planning for Married Couples
When one spouse needs nursing home care, Pennsylvania Medicaid rules are designed to protect the healthy spouse while helping the spouse who needs care qualify for long-term care benefits. These rules can be complex, but careful planning may help preserve income, protect assets, and reduce the risk of unnecessary spend-down.
Community Spouse Resource Allowance (CSRA)
Under Pennsylvania Medicaid rules, the spouse who remains at home, often called the community spouse, may keep a protected share of the couple’s countable resources. For 2026, that protected amount is generally one-half of the couple’s combined countable assets, subject to a minimum of $32,532 and a maximum of $162,660.
The spouse who needs long-term care, often called the institutionalized spouse, must usually reduce countable resources to Medicaid limits before benefits can begin.
Monthly Income Protection
Pennsylvania also allows income protection for the community spouse through the Community Spouse Monthly Maintenance Needs Allowance. In 2026, the minimum monthly maintenance needs allowance is $2,705, and the maximum is $4,066.50.
IRAs and Retirement Accounts
The treatment of retirement accounts depends on ownership and circumstances. Because IRA treatment can affect eligibility, it is important to evaluate how retirement funds fit into the couple’s overall Medicaid planning strategy.
Protecting the Family Home
The family home is often a central concern in Medicaid planning. In Pennsylvania, the home may be protected in certain situations, especially when the community spouse continues to live there. Planning for the home should also include estate planning, because Medicaid Estate Recovery may become an issue later.
Can I just give my house to my children?
Usually not without consequences. Pennsylvania’s 5-year look-back means a gift made within 60 months of applying for long-term care Medicaid can trigger a penalty period when Medicaid won’t pay for care. There are also tax costs: children who receive a house as a gift generally take over your original cost basis, so they may owe capital gains tax on the full appreciation if they sell. Heirs who inherit the home at death typically get a “stepped-up” basis, which can eliminate most of that tax, though the home may then be exposed to Medicaid Estate Recovery. Because the right approach depends on your situation, consult an elder law attorney before transferring the property.
Protect the healthy spouse
Schedule a consultation with our Pennsylvania estate planning and elder law attorneys today.
