Love, Care, and Keeping the Home: How Medicaid Can Help One Spouse Without Impoverishing the Other

Meet John and Mary. John is 75 and his health has declined significantly over the past year. After several hospital stays and a recent fall, his doctors have recommended that he move to a nursing home for 24/7 care. Mary, his 65-year-old wife, is still healthy, living at home, and managing their daily affairs. But like many families, Mary is terrified—not just for John’s health, but for their financial future. She’s heard that nursing homes cost upwards of $6,000–$9,000 per month. Their savings are modest, their home is paid off, and their income is steady—but not enough to cover those kinds of costs. She’s been told they’ll have to spend everything down before John qualifies for Medicaid. Luckily, Mary calls an elder law attorney and learns that is some very bad advice.

Texas follows Medicaid spousal impoverishment rules—laws specifically designed to prevent the healthy spouse (called the “community spouse”) from losing everything when the other spouse needs nursing home care. These rules allow Mary to keep a substantial portion—and in many cases, all—of the couple’s income and assets.

Medicaid rules allow Mary to keep the home, one car, personal belongings, and a portion of the couple’s savings—called the Community Spouse Resource Allowance (CSRA). In 2025, this amount can be up to $157,920. With smart planning, Mary may be able to keep even more. Medicaid also allows Mary to keep all of her own income, and in some cases, a portion of John’s income as well. That means she can continue paying bills, buying groceries, and living independently—without going broke to pay for care.

With the help of an experienced elder law attorney, families like John and Mary’s can often qualify for Medicaid sooner than they thought—preserving tens or even hundreds of thousands of dollars in the process. Too many families spend everything they have because they don’t know what’s allowed. The Medicaid rules are complex, and one misstep—like giving away assets or applying too soon—can trigger penalties and delays. That’s why working with a qualified elder law attorney is essential.

At The Toups Law Firm, Medicaid planning is one of our core areas of focus. Ruth-Ann Toups is a Certified Elder Law Attorney and she is Board Certified in Estate Planning & Probate Law by the Texas Board of Legal Specialization. We work with families like yours to protect assets, qualify for benefits, and ensure dignity and quality of care—without sacrificing the financial stability of the healthy spouse. You may have more options than you think. Let us help you build a plan that protects both your loved one and your future.