ALW guide
What happens to the spouse at home when one spouse applies for ALW?
When one spouse moves to an assisted-living home under ALW and the other stays home, Medi-Cal's spousal impoverishment rules can protect income and assets for the spouse at home. The county applies them.
Medi-Cal has spousal impoverishment rules so the spouse who stays home is not left without income or assets when the other spouse needs long-term care. Federal rules say they cover people in a nursing facility and certain people getting home and community-based waiver services; the county applies California's version when it decides the Medi-Cal that the Assisted Living Waiver (ALW) needs. Beta ALW can tell you what to ask the county.
Important: The county decides Medi-Cal, including whether and how the spousal rules apply to the person applying for ALW, and it gives the current California amounts. This page explains the rules in words and prints only the federal 2026 standards, with their source. The California Department of Health Care Services (DHCS) decides ALW eligibility after a nurse assessment. Beta's ALW team cannot promise Medi-Cal, eligibility, an opening or a date.
Why a couple's Medi-Cal is different
ALW needs full-scope Medi-Cal with no monthly share of cost, and the county decides that by looking at income and assets. For a married person the county looks at the couple. Without a protection, the spouse at home could be left with too little to live on. The spousal impoverishment rules are that protection. Federal Medicaid rules describe them this way: a certain amount of the couple's combined resources is protected for the spouse living in the community, and that spouse can keep a monthly income allowance. The rules were written for a spouse in a nursing facility and also cover certain people getting home and community-based waiver services, which is the family ALW belongs to.
The two protections, in words
| Protection | What it does | Who sets the amount |
|---|---|---|
| Protected resources for the spouse at home (the community spouse resource allowance) | Part of the couple's combined countable assets is set aside for the spouse at home and not counted against the spouse applying. | Federal rules set a yearly minimum and maximum; each state sets its own figure within them, and the county applies it. |
| Monthly income allowance for the spouse at home (the monthly maintenance needs allowance) | Income can be set aside each month so the spouse at home has at least a set amount to live on. | Federal rules set a yearly minimum and maximum; each state sets its own figure within them, and the county applies it. |
For 2026, the federal standards in the Centers for Medicare & Medicaid Services bulletin of April 27, 2026 are: protected resources from $32,532.00 to $162,660.00; a monthly maintenance needs allowance of at most $4,066.50, with a minimum of $2,705.00 that takes effect July 1, 2026; and a home equity limit of $752,000 to $1,130,000. These are the federal brackets, not California's figure. The county gives California's current amounts; DHCS's spousal impoverishment page is where DHCS publishes them.
What the county may ask for
When the county applies the spousal rules to someone applying for home and community-based waiver services, it may ask the doctor to complete form MC 604 MDV, the medical verification for those services. It may also send form MC 604, "Additional Income and Property Information Needed for Medi-Cal", when it needs more detail on the couple's income or property. Answer every county letter by its deadline. How a senior gets full-scope Medi-Cal before the ALW.
The home the couple owns
The county decides how the home is treated, for the spouse who applies and for the spouse who stays in it, under Medi-Cal's property rules. Ask the county eligibility worker and get the answer in writing; this page does not state those rules. Medi-Cal's 2026 income and asset limits, and what counts.
Room and board for the spouse who moves
ALW never pays room and board. The spouse who moves into the assisted-living home pays the room and meals from income, after the county has set any allowance for the spouse at home. Ask the Care Coordination Agency to work the monthly numbers through with you before anyone moves. What ALW pays, and what you pay.
What people ask
Will my spouse lose the house if I enroll in ALW?
The county decides how the home is treated under Medi-Cal's property rules, for the applicant and for the spouse who stays in it. Ask the eligibility worker, in writing, before the application goes in. Beta's ALW team does not give that answer.
Do the spousal rules apply to assisted living, or only to nursing homes?
Federal rules say they cover people in a nursing facility and certain people getting home and community-based waiver services. ALW is a home and community-based waiver. Whether and how they apply to a particular couple is the county's decision when it decides the Medi-Cal that ALW needs.
Where are California's current amounts?
The county gives them when it decides the case, and DHCS publishes them on its spousal impoverishment page. This page prints only the 2026 federal standards from the CMS bulletin, with the bulletin's date.
About this informationReviewed October 26, 2026. Program details may change. View official sources and page limitations.
Written by Beta's ALW team and reviewed by Sergio B., Program Coordinator, against the official sources this page lists; facts checked through October 26, 2026. Where this page and an official source differ, the source controls.
This page gives general California ALW information. DHCS decides eligibility after the nurse assessment and releases openings. Each home decides its own admissions. Nothing here is an eligibility decision or a promise of enrollment, and it does not guarantee a place in a home. You may choose any Care Coordination Agency listed by DHCS and any participating home.
Something out of date? Tell Beta's ALW team.