Nevada Medicaid Treatment of Home and IRA for Couples Age 65+ Entering Skilled Nursing, Custodial Care, or Cancer Treatment

This document explains how Nevada Medicaid evaluates a $500,000 home and a $50,000 IRA when one or both spouses age 65 or older enter skilled nursing, custodial care, or require cancer treatment. Nevada follows federal Medicaid long-term care rules, including spousal impoverishment protections, home exemptions, and estate recovery limitations.

1. Treatment of the $500,000 Home

Nevada Medicaid treats the primary residence as an exempt asset as long as one spouse continues living in the home. The value of the home does not matter; Nevada does not impose a home equity cap when a community spouse resides there. If one spouse enters long-term care and the other remains at home, the home is fully protected and cannot be counted toward Medicaid eligibility.

If both spouses enter long-term care simultaneously, the home remains exempt if either spouse expresses an intent to return home. Nevada accepts this intent even if return is medically unlikely. The home therefore remains protected during both spouses’ lifetimes.

Estate recovery in Nevada occurs only after both spouses have died. Recovery applies only to assets passing through probate. If the home is placed in a living trust or otherwise avoids probate, Nevada cannot recover against it. This allows the home to remain protected even after both spouses’ deaths.

2. Treatment of the $50,000 IRA

Nevada follows federal Medicaid rules for retirement accounts. If the IRA belongs to the community spouse, it is fully exempt and does not count toward Medicaid eligibility. The community spouse may retain the IRA without spend-down requirements.

If the IRA belongs to the spouse entering long-term care, Nevada counts the IRA as a resource unless it is in payout status. When the IRA is in periodic required minimum distribution status, Nevada treats the principal as exempt and counts only the monthly distribution as income. This allows the IRA to be preserved rather than liquidated.

If both spouses enter long-term care, each IRA must be evaluated individually. IRAs in payout status remain protected. IRAs not in payout status may be counted and may require conversion to payout status to avoid spend-down.

3. Spousal Impoverishment Protections

Nevada applies federal spousal impoverishment rules when one spouse enters long-term care. The community spouse is allowed to retain a significant portion of the couple’s assets under the Community Spouse Resource Allowance. In 2026, the community spouse may keep approximately $154,000 in countable assets, in addition to exempt assets such as the home and retirement accounts.

The community spouse also retains all personal income. None of the community spouse’s income is taken to pay for the institutionalized spouse’s care. The institutionalized spouse contributes income toward the cost of care, minus a small personal needs allowance.

4. If Both Spouses Enter Skilled Nursing or Custodial Care

When both spouses enter long-term care, Nevada Medicaid evaluates them as a couple. The home remains exempt if either spouse intends to return home. The IRA remains exempt if in payout status. Countable assets must be reduced to the couple’s Medicaid resource limit, which is significantly lower than the spousal impoverishment allowance. Exempt assets, including the home and properly structured IRAs, remain protected.

After both spouses pass away, Nevada may pursue estate recovery. Recovery applies only to probate assets. If the home is held in a living trust or passes outside probate, Nevada cannot recover against it.

5. Cancer Treatment Under Nevada Medicaid

Cancer treatment falls under standard Medicaid medical coverage rather than long-term care rules. Asset limits for medical Medicaid differ from long-term care Medicaid. However, for individuals age 65 and older, Nevada uses the federal SSI-related Medicaid rules, which include asset limits but exempt the home and certain retirement accounts. The $500,000 home remains protected. The $50,000 IRA is exempt if in payout status.

If cancer treatment leads to long-term custodial care, the long-term care rules described above apply.

6. Summary Table

Asset	Outcome When One Spouse Enters Care	Outcome When Both Spouses Enter Care
Home ($500,000)	Fully exempt; protected; no spend-down; no lien; no recovery while community spouse lives.	Exempt if either spouse intends to return; protected until both spouses die; avoid probate to prevent recovery.
IRA ($50,000)	Exempt if owned by community spouse; exempt if in payout status for institutionalized spouse.	Exempt if in payout status; may require conversion to payout status to avoid spend-down.
Estate Recovery	No recovery until both spouses have died; home protected while community spouse lives.	Recovery only against probate assets; home protected if placed in trust or otherwise avoids probate.

7. Overall Consequence

In Nevada, a $500,000 home and a $50,000 IRA can both be preserved even if one or both spouses age 65 or older enter skilled nursing, custodial care, or require cancer treatment. The home remains exempt during both spouses’ lifetimes. The IRA remains exempt if properly structured in payout status. Estate recovery can be avoided by ensuring the home does not pass through probate.