One Spouse Needs Care? How MassHealth Protects the Other Spouse in MA

July 25, 2025
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When a spouse requires long-term care, whether in a nursing home or through home and community-based services, the financial implications can be overwhelming. For many couples in Massachusetts, a primary fear is that the cost of care will deplete their life savings, leaving the “healthy” or “community” spouse in financial distress.

Fortunately, MassHealth, Massachusetts’ Medicaid program, has specific provisions designed to protect the financial well-being of the community spouse. These “spousal impoverishment” rules are crucial for ensuring that one spouse can receive necessary care without bankrupting the other. This guide will walk you through these vital protections, addressing common fears and offering clarity.

Understanding the Fear: Why Spouses Worry

The fear is legitimate. Long-term care costs in Massachusetts are among the highest in the nation. Without assistance, a nursing home stay can quickly consume a couple’s assets, including their home, savings, and investments. The thought of one spouse being left with nothing while the other receives care is a deeply unsettling prospect.

Common fears include:

Losing all savings: The belief that all joint assets must be “spent down” to qualify for MassHealth.
Forced sale of the home: Worry that the family home will need to be sold to cover care costs.
Loss of income: Concern that the community spouse will be left without sufficient income to live on.
Future financial insecurity: The dread of facing old age alone with no financial cushion.

These fears are precisely what the spousal impoverishment rules aim to mitigate.

An elderly person sits alone on a park bench thinking about how masshealth can protect his spouse;, surrounded by fallen autumn leaves on the grass, with trees displaying orange foliage in the background. The scene appears peaceful and contemplative.

The Cornerstone of Protection: Spousal Impoverishment Rules

The spousal impoverishment provisions under federal law and implemented by MassHealth are designed to prevent the community spouse from becoming impoverished when their partner needs long-term care funded by MassHealth.

There are two primary mechanisms for this protection:

Community Spouse Resource Allowance (CSRA): This rule allows the community spouse to retain a certain amount of the couple’s combined countable assets.

Minimum Monthly Maintenance Needs Allowance (MMMNA): This rule ensures the community spouse has a minimum amount of monthly income.

Let’s break down how these work in Massachusetts, using the most current figures available for 2025.

Protecting Assets: The Community Spouse Resource Allowance (CSRA)

When one spouse (the “institutionalized spouse”) applies for MassHealth long-term care benefits, MassHealth assesses the couple’s total countable assets as of the “snapshot date” (generally, the first day the institutionalized spouse entered a medical institution or began receiving home and community-based services for at least 30 consecutive days).

What the CSRA means for you:

Joint Assets are Considered: All assets, regardless of whose name they are in, are considered jointly owned for MassHealth eligibility purposes.
The “Snapshot” Amount: MassHealth calculates the total countable assets owned by both spouses on the snapshot date.
Community Spouse’s Share: The community spouse is allowed to keep a portion of these countable assets. For 2025, the maximum Community Spouse Resource Allowance (CSRA) is $157,920.
Minimum Protection: There’s also a minimum amount the community spouse can keep. If 50% of the combined assets falls below a certain threshold, the community spouse is allowed to keep that minimum. For 2025, this minimum is $31,584.
Applicant’s Limit: The spouse applying for MassHealth (the institutionalized spouse) is generally allowed to keep only $2,000 in countable assets.

Example: If a couple has $200,000 in countable assets, the community spouse can keep $100,000 (50% of $200,000), which is within the 2025 maximum of $157,920. The institutionalized spouse would then need to “spend down” their portion to $2,000.

Modern two-story house with large windows, double garages, and manicured landscaping, featuring concrete walkways, lush greenery, and exterior lights at dusk under a clear blue sky. An example of a non-countable asset if used as a primary residence.

Key Assets That Are Often Exempt (Non-Countable):

It’s crucial to understand that not all assets are counted. Common exempt assets include:

Primary Residence: The family home is generally exempt, provided the community spouse lives there, or there is an intent to return home by the institutionalized spouse. There is an equity interest limit, which in 2025 is $1,097,000.

To learn more about how your home is treated, visit our guide on MassHealth Asset Rules.

One Motor Vehicle: Usually, one vehicle of any value is exempt.
Personal Belongings: Household furnishings, clothing, and personal effects are typically exempt.
Irrevocable Burial Trusts/Prepaid Funeral Contracts: Funds set aside for funeral and burial expenses, up to a certain limit (e.g., $1,500 for irrevocable burial bank accounts), if structured correctly.
Life Insurance: Term life insurance (no cash value) is exempt. For whole life or universal life insurance, the cash surrender value is countable if the face amount exceeds $1,500.

Understanding the distinction between countable and non-countable assets is vital for effective MassHealth planning. Our team at Brunelle Medicaid Consultants specializes in helping families navigate these distinctions.

Protecting Income: The Minimum Monthly Maintenance Needs Allowance (MMMNA)

The MMMNA is designed to ensure the community spouse has enough income to live on without becoming impoverished.

How the MMMNA works:

Baseline Income: MassHealth determines a minimum monthly income that the community spouse is allowed to retain. For the period of July 1, 2025, to June 30, 2026, the Minimum Monthly Maintenance Needs Allowance (MMMNA) in Massachusetts is $2,643.75.
Income Transfer: If the community spouse’s own income (from sources like Social Security, pensions, etc.) falls below this MMMNA, they can receive a portion of the institutionalized spouse’s income to bring their total income up to this level. This is known as a “spousal income allowance” or “spousal diversion.”
Excess Shelter Allowance: If the community spouse’s housing costs (rent/mortgage, taxes, insurance, utilities) exceed a certain “shelter standard” (for July 1, 2025 – June 30, 2026, the Excess Shelter Allowance is $793.13 / month, with a standard utility allowance of $890 in MA), they may be able to keep even more of the institutionalized spouse’s income, up to a maximum.
Maximum Allowance: The combined income a community spouse can retain, even with the Excess Shelter Allowance, is capped by the Maximum Monthly Maintenance Needs Allowance. For 2025, this maximum is $3,948.

Example: If the institutionalized spouse has a pension of $2,000 per month and the community spouse only receives $1,000 per month in Social Security, and their housing costs are average, the community spouse could receive $1,643.75 from the institutionalized spouse’s pension ($2,643.75 MMMNA – $1,000 community spouse’s income), bringing their total income up to the MMMNA.

Important Considerations and Planning Strategies

While the CSRA and MMMNA offer significant protections, navigating the MassHealth application process and optimizing these allowances can be complex. Here are additional factors and strategies to consider:

The “Look-Back” Period: MassHealth has a five-year “look-back” period for asset transfers. Any assets gifted or transferred for less than fair market value within this period can result in a penalty period of ineligibility. Proper planning is essential to avoid these penalties.
Medicaid Compliant Annuities: In some situations, an immediate annuity purchased by the community spouse can convert excess countable assets into an income stream for the community spouse, helping the institutionalized spouse qualify for MassHealth. These must be structured as “Medicaid compliant annuities” to avoid being considered a disqualifying transfer.
Irrevocable Trusts: For proactive planning, an irrevocable trust (such as a Medicaid Asset Protection Trust) can be used to protect assets from being counted by MassHealth after the five-year look-back period has passed. This is a sophisticated strategy that requires expert legal and financial guidance.
Estate Recovery: After the death of a MassHealth recipient, the state may seek to recover the costs of care from their probate estate. However, significant protections exist, including exemptions when a surviving spouse or a permanently disabled child resides in the home. As of September 6, 2024, Massachusetts has also limited estate recovery to only federally mandated recovery for nursing home and certain other long-term care costs, and will not pursue recovery for estates valued at $25,000 or less.

Understanding estate recovery is a key part of long-term care planning. Learn more about MassHealth Estate Recovery on our website.

Spousal Refusal: In very specific circumstances, a community spouse may refuse to contribute their assets towards the institutionalized spouse’s care. This is a complex legal strategy with significant implications and should only be pursued with the guidance of an experienced elder law attorney.

A doctor in a white coat uses a digital tablet with a stylus, to explain how masshealth protects spouses; sitting beside a patient. Both are seated, and only their torsos and hands are visible. The patient’s hands are clasped together in their lap.

Don’t Face MassHealth Alone

The MassHealth application process, especially when a married couple is involved, is highly detailed and can be fraught with potential pitfalls. Errors or misunderstandings can lead to delays in eligibility, denial of benefits, or unnecessary depletion of the community spouse’s assets.

At Brunelle Medicaid Consultants, we have over two decades of experience helping Massachusetts families navigate the intricacies of MassHealth. Our team of highly trained Medicaid specialists, attorneys, and financial advisors understands the specific challenges and fears faced by spouses. We offer comprehensive services including:

Medicaid Applications for Short or Long-Term Care
Conversions, Renewals, and Eligibility Reviews
Appeals and Hardship Appeals
Guidance on Annuities, Trusts, and Deed Transfers
And more, designed to lessen the burden and ensure the best possible outcome for your family.

We work diligently to ensure you understand all available options, protect your financial security, and secure the care your loved one needs. Don’t let fear paralyze you. Reach out to Brunelle Medicaid Consultants today for a consultation.Contact Brunelle Medicaid Consultants for expert assistance with your MassHealth application and planning needs. Visit our Services Page to learn more about how we can help.