Spousal Protections in Medicaid Planning

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When one spouse needs nursing home care or long-term Medicaid services, the last thing the other spouse should worry about is losing everything they’ve worked for. Georgia law, backed by federal Medicaid rules, includes real protections designed to keep the at-home spouse financially stable. These are called spousal impoverishment protections, and they matter more than most people realize. At Slowik Estate Planning in Atlanta, Georgia, we help families understand these rules and plan ahead before a crisis forces their hand.

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What Are Spousal Impoverishment Protections?

The expense of nursing home care can rapidly deplete the lifetime savings of elderly couples. In 1988, Congress enacted provisions to prevent what has come to be called “spousal impoverishment,” which left the spouse still living at home with little or no income or resources. Those federal protections are still in place today and apply directly to Georgia families.

These provisions help ensure that community spouses are able to live out their lives with independence and dignity. Under the Medicaid spousal impoverishment provisions, a certain amount of the couple’s combined resources is protected for the spouse living in the community. Think of it this way: if your husband or wife needs nursing home care and applies for Medicaid, you do not have to spend down every dollar the two of you own just to get them approved.

All assets of a married couple are considered jointly owned, regardless of the long-term care Medicaid program for which one or both spouses are applying. That sounds alarming at first. But the law builds in specific protections that carve out a meaningful amount for the spouse who stays home. There are two main tools here: the Community Spouse Resource Allowance (CSRA) for assets, and the Monthly Maintenance Needs Allowance (MMNA) for income. Both are explained in detail below.

These rules apply to Georgia Nursing Home Medicaid and Home and Community Based Services (HCBS) Waiver programs. The CSRA is not applicable for Regular Medicaid. So the type of Medicaid program your spouse applies for matters a great deal. An estate planning attorney in Atlanta can help you identify which program applies to your situation and how to make the most of these protections.

The Community Spouse Resource Allowance (CSRA) in Georgia

There is a Community Spouse Resource Allowance (CSRA) that protects a larger amount of a couple’s countable assets for the non-applicant spouse of a Nursing Home Medicaid or Medicaid Waiver applicant. This is one of the most important protections in Georgia Medicaid law, and knowing the current numbers is essential for planning.

In 2026, the community spouse (the non-applicant spouse) can retain up to $162,660 of the couple’s countable assets. While the exact amount varies by state, the federal government sets a minimum and maximum “resource standard.” In 2026, the minimum CSRA is $32,532 and the maximum CSRA is $162,660. Georgia uses the maximum figure, which is a real benefit for Atlanta-area families.

In most states in 2026, the asset limits for Nursing Home Medicaid and HCBS Waivers are $2,000 for an individual and a combined $3,000 or $4,000 for a married couple with both spouses applying. But when just one spouse in a married couple is applying, the applicant spouse can keep up to $2,000, and the CSRA allows the non-applicant spouse to keep up to $162,660, depending on the state and the couple’s financial situation.

So what counts as a “countable” asset? Countable assets include cash, stocks, bonds, investments, cryptocurrency, bank accounts (savings, checking, money market), and real estate in which one does not reside. There are also many assets that are non-countable (exempt). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts (up to $10,000 in Georgia), and generally one’s primary home. Proper asset protection planning can make a significant difference in how much of your estate is preserved.

The Monthly Maintenance Needs Allowance (MMNA) for the At-Home Spouse

Protecting assets is only half the picture. Income protection matters just as much. If your spouse enters a nursing home and their income was the primary source of household support, you could be left struggling to pay the mortgage or basic bills. Georgia law addresses this directly through the Monthly Maintenance Needs Allowance.

The non-applicant spouse may be entitled to a Monthly Maintenance Needs Allowance (MMNA) from their applicant spouse. This is the minimum amount of monthly income a non-applicant spouse needs to prevent spousal impoverishment. In 2026, the MMNA in Georgia is $4,066.50. If the non-applicant’s monthly income falls below this amount, income can be transferred from the applicant to the non-applicant spouse to bring their income up to this level.

Here is a practical example to make this clear. Georgia uses a standard figure of $4,066.50 per month. A non-applicant spouse in Georgia with a monthly income of $1,000 is automatically entitled to $3,066.50 per month from their applicant spouse to bring their income up to $4,066.50 per month.

A non-applicant spouse whose own income is $4,066.50 per month or greater is not entitled to an MMNA or Spousal Income Allowance. When only one spouse of a married couple applies for Nursing Home Medicaid or a HCBS Medicaid Waiver, only the income of the applicant spouse is counted. The income of a non-applicant spouse does not impact the applicant spouse’s income eligibility. That is a critical point. The at-home spouse’s income will not disqualify the applying spouse from receiving benefits.

Georgia’s MMNA figure is among the highest in the country. The federal Maximum MMNA is $4,066.50, effective January 1, 2026 through December 31, 2026. There are 14 states that currently use $4,066.50 as their MMNA, which means community spouses are entitled to that amount regardless of their shelter costs. Georgia is one of those 14 states, which is a meaningful advantage for Atlanta families.

The Home, the Look-Back Period, and What You Need to Know

Many couples worry about losing their home when a spouse applies for Medicaid. Georgia law includes a direct protection for this. The home will automatically be exempt if the applicant’s spouse, child under 21 years old, or permanently blind or disabled child of any age lives in it. So if you remain living in the family home, the home is protected during the Medicaid application process.

If this is not the case, there is a home equity interest limit of $752,000 in 2026. Home equity is the value of the home minus any outstanding debt against it. Equity interest is the amount of the home’s equity owned by the applicant. Most Georgia families will fall well below this threshold, but it is still important to understand how the state values your property.

The Look-Back Period is another issue that catches families off guard. Georgia has a Medicaid Look-Back Period of 60 months for Nursing Home Medicaid and Medicaid Waivers. During this period, Medicaid scrutinizes all asset transfers, including those made by one’s spouse, for assets that were gifted. This means any asset transferred to family members or others in the five years before applying could trigger a penalty period, delaying Medicaid coverage.

Changes are also coming through federal legislation. Under the One Big Beautiful Bill Act (H.R. 1, 119th Congress), Section 71108 caps home equity limits for Medicaid nursing facility or other long-term care services beginning in 2028. This means the rules around home equity and Medicaid eligibility will shift in the coming years. Planning now, before those changes take effect, is the smart move. An Atlanta estate planning lawyer at Slowik Estate Planning can help you understand how these upcoming changes affect your family’s plan.

Medicaid Planning Strategies for Married Couples in Georgia

Understanding the rules is one thing. Using them wisely is another. There are several legal strategies that married couples in Georgia can use to protect assets and income while still qualifying one spouse for Medicaid. These strategies require careful planning and proper legal guidance. None of them involve fraud or hiding assets. They are built directly into the law.

One approach involves repositioning countable assets into exempt ones before applying. For example, paying off a mortgage, making home improvements, or purchasing an exempt vehicle can reduce countable assets without violating Medicaid rules. Another strategy involves the use of a Qualified Income Trust (QIT), also called a Miller Trust. Each month, income that is over the Medicaid limit is deposited into this trust account. That money is then used to help pay for medical and care-related expenses. Because the excess income is legally diverted into the trust, it is no longer counted against the applicant, allowing them to become income-eligible. Setting up a QIT requires specific legal steps, but it is a standard and essential tool for many Georgia families.

Annuities, promissory notes, and certain trust structures can also play a role in Medicaid planning for married couples. Some of these tools can convert countable assets into income streams that benefit the community spouse while helping the applying spouse meet the asset limit. These strategies require careful timing and documentation, especially given the 60-month Look-Back Period.

Congress has also proposed new community engagement requirements under the One Big Beautiful Bill Act. Beginning in 2027, certain Medicaid enrollees must demonstrate at least 80 hours per month of work, community service, or educational activity. Exemptions exist for those with serious medical conditions or dependent children aged 13 or younger. These rules could affect how some families plan for long-term care. Staying ahead of these changes is exactly why working with a qualified attorney matters.

If your family has international assets or ties, Medicaid planning becomes even more layered. International estate planning can intersect with Medicaid eligibility in ways that require careful legal review. Similarly, estate tax planning in Atlanta, Georgia should be coordinated with any Medicaid plan to avoid unintended tax consequences. Slowik Estate Planning works with clients to make sure all pieces of their estate plan work together.

Why You Should Plan Now, Not Later

Medicaid planning is not something you do in the middle of a health crisis. By then, your options are limited. The 60-month Look-Back Period means that transfers made years before an application can still affect eligibility. The best time to plan is well before a nursing home need arises.

Georgia families also need to stay aware of changing federal rules. The One Big Beautiful Bill Act includes provisions that will reshape Medicaid eligibility and enrollment starting as early as the first quarter after December 31, 2026. Section 71107 of that legislation requires state Medicaid programs to redetermine eligibility every six months for certain enrollees. Section 71112 shortens the window for retroactive Medicaid coverage, limiting it to one or two months prior to the application filing date, down from the current three months. These changes could affect how quickly your family can access benefits if a crisis hits unexpectedly.

The expense of nursing home care can range from $5,000 to $8,000 a month or more. In the Atlanta metro area, costs can run even higher. Waiting until a loved one is already in a facility to begin planning often means fewer options and greater financial loss. The protections built into Georgia and federal law are only useful if you know how to access them in time.

At Slowik Estate Planning, located in Atlanta, Georgia, our team works with families to build Medicaid plans that protect the community spouse, preserve family assets, and ensure the applying spouse gets the care they need. Every family’s situation is different, and the right plan depends on your specific assets, income, health, and goals. We encourage you to reach out to us before a crisis makes the decision for you. Results in any given case depend on the specific facts and circumstances involved, and past outcomes do not guarantee similar results in future matters.

FAQs About Spousal Protections in Medicaid Planning in Georgia

How much can my spouse keep in assets if I apply for Medicaid in Georgia?

In 2026, the community spouse (the at-home spouse) can keep up to $162,660 in countable assets under Georgia’s Community Spouse Resource Allowance. The applying spouse is generally limited to $2,000 in countable assets. Assets like your primary home, one vehicle, and personal belongings are typically exempt and do not count toward these limits. Proper planning can help you make the most of these protections before you apply.

Will my income be counted when my spouse applies for Georgia Medicaid?

No. When only one spouse applies for Nursing Home Medicaid or a Medicaid Waiver in Georgia, only the applying spouse’s income is counted toward the eligibility limit. Your income as the at-home spouse does not affect your spouse’s ability to qualify. You may also be entitled to receive a portion of your spouse’s income through the Monthly Maintenance Needs Allowance if your own income falls below $4,066.50 per month in 2026.

What is the Look-Back Period and why does it matter for couples?

Georgia’s Medicaid Look-Back Period is 60 months (five years). Medicaid reviews all asset transfers made by both spouses during that window. If assets were given away or sold below fair market value during that period, Medicaid can impose a penalty that delays coverage. This is why planning ahead, well before a nursing home need arises, is so important. Transfers made between spouses are generally allowed, but the rules are specific and must be followed carefully.

Is our home protected if my spouse enters a nursing home?

Yes, in most cases. If you continue to live in the home, it is automatically exempt from Medicaid’s asset calculation. The home will not be counted against your spouse’s eligibility while you reside there. However, Medicaid can pursue estate recovery after both spouses have passed, which is why including your home in a broader estate plan is important. An attorney at Slowik Estate Planning can help you understand how to protect your home both now and for the future.

Are there new federal rules that could change Georgia Medicaid planning in 2026 and beyond?

Yes. The One Big Beautiful Bill Act (H.R. 1, 119th Congress) includes several provisions that will affect Georgia Medicaid planning in the coming years. These include more frequent eligibility redeterminations starting in early 2027, a shorter retroactive coverage window beginning after December 31, 2026, new home equity caps for long-term care starting in 2028, and new community engagement requirements for certain enrollees. These changes make it even more important to work with a qualified attorney now to build a plan that accounts for what is coming.

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