Can a Spouse Keep the House When a Partner Is on Hospice in a Nursing Home?

In most cases, yes. A spouse living at home can usually keep the house when their partner is on hospice in a nursing home, even if Medicaid pays for the room. Federal "spousal impoverishment" rules protect the home, part of the couple's savings and a monthly income for the spouse at home. The protections do not mean everything is shielded. Savings above the protected share count toward the nursing home spouse's Medicaid eligibility, and most of that spouse's own income goes toward the cost of care.

Why this comes up on hospice

Medicare's hospice benefit pays for the hospice team, comfort medications and equipment. It does not pay nursing home room and board. For a resident who qualifies for Medicaid, Medicaid can pay the room through the hospice in states that cover hospice, as explained in does Medicaid pay nursing home room and board on hospice. Medicaid has income and asset limits, so a married couple has to deal with the spousal rules.

The house

Under federal law the home is excluded from the resources counted for Medicaid. Two more protections apply while the spouse lives in it:

• No home equity cap. Medicaid normally denies long-term care coverage to people whose home equity is above a limit ($752,000 to $1,130,000 in 2026, depending on the state). That limit does not apply when a spouse lives in the home.
• No lien while the spouse lives there. A state may not place a lien on the home of a nursing home resident while their spouse is lawfully living in it.

Moving the house into the at-home spouse's name is also allowed. Federal law exempts transfers of a home to a spouse from Medicaid's transfer penalty. What can happen after both spouses have died is covered in can Medicaid take the house after paying for hospice in a nursing home.

Savings

Medicaid takes a snapshot of everything either spouse owns, whoever's name it is in, at the start of the first continuous period of nursing home care. Federal law sets the at-home spouse's protected share as roughly half of the couple's countable resources, within a floor and a ceiling. States may set the floor higher, up to the ceiling. For 2026, CMS published these limits:

2026 spousal impoverishment standard	Amount
Minimum community spouse resource standard	$32,532
Maximum community spouse resource standard	$162,660
Minimum monthly maintenance needs allowance (from July 1, 2026; most states)	$2,705 ($3,381.25 Alaska, $3,111.25 Hawaii)
Maximum monthly maintenance needs allowance	$4,066.50
Home equity limit (not applied while a spouse lives in the home)	$752,000 to $1,130,000

Countable savings above the protected amount are treated as available to the spouse in the nursing home, and they generally have to be reduced before Medicaid eligibility begins. Once eligibility is approved, the at-home spouse's own resources are no longer counted against the partner in the nursing home.

Income

The at-home spouse's own income, such as their Social Security or pension paid in their name, is not counted as available to the spouse in the nursing home. If the at-home spouse's income falls below the state's maintenance allowance, part of the nursing home spouse's income can be set aside for them. Since July 1, 2026, that allowance is at least $2,705 a month in most states ($3,381.25 in Alaska and $3,111.25 in Hawaii), and in 2026 it is generally no more than $4,066.50.

From the nursing home spouse's income, Medicaid first allows a personal needs allowance (federal minimum $30 a month), then the spousal allowance, any allowance for dependent family members living with the at-home spouse, and certain medical expenses. What is left goes to the nursing home as the resident's monthly share of the cost.

A timing point for hospice families

The spousal rules are written for a spouse who is likely to be in a nursing home or medical institution for at least 30 consecutive days. Hospice patients sometimes have short stays. Ask your state Medicaid agency how it applies the rules in your situation before you assume either outcome.

If the protected amounts are not enough

Either spouse can ask for a fair hearing if they disagree with the protected-savings or income figures. If the at-home spouse needs more income because of exceptional circumstances that cause significant financial duress, the allowance can be raised. Federal law requires a hearing on the protected-savings amount within 30 days of the request.

Frequently asked questions

Will the at-home spouse have to sell the house?

Not to qualify the partner for Medicaid. The home is excluded while the spouse lives there, the equity cap does not apply, and the state cannot place a lien on it during that time.

Do these rules apply if my husband is on hospice at home, not in a nursing home?

The core rules are written for a spouse in a nursing home or medical institution. Through September 30, 2027, federal law also requires states to apply them to married people who are eligible for Medicaid home and community-based services, such as waiver services at home. Ask your state Medicaid agency whether your husband's care at home falls under these rules.

Should we give money to the children to protect it?

Be careful. Medicaid looks back 60 months at transfers made for less than fair market value, and transfers can delay eligibility. Transfers to a spouse are exempt from that penalty. Get advice from an elder law attorney or your state Medicaid agency before moving any assets.

Does electing hospice change any of this?

No. The spousal rules are Medicaid financial rules, and they are the same whether or not the resident is on hospice. Hospice changes who provides comfort care, not how Medicaid counts a couple's money.

Your practical next step

Before applying, ask the state Medicaid agency, or a hospice social worker who can point you to it, for a resource assessment. Federal law lets either spouse request one at the start of nursing home care, and it shows how the couple's assets will be divided. If you ask for it separately from a Medicaid application, the state may charge a fee. Keep copies of everything. For broader money questions, see financial help and resources for hospice families, and compare hospices near you to find a team with a strong social work staff.