Recently, the U.S. Supreme Court upheld Wisconsin's use of the "income first" method of counting available income of a well spouse when the sick spouse is institutionalized. At a fair hearing, a well spouse may ask to retain assets in excess of his or her Community Spouse Resource Allowance (CSRA) for the purpose of generating enough income to bring that spouse's income up to the staatutorily mandated minimum amount (currently $2,232 per month). However, instead of allowing the well spouse to increase their CSRA for this purpose, many states require the sick spouse to turn over to the well spouse so much of his or her income required to bring the well spouse's income up to the mandated minimum amount. The net effect of this is that states may require more of a couple's resources to be spent before Medicaid will cover nursing home care for one spouse thereby leaving fewer assets for the spouse at home. In light of this, whenever excess resources are involved, an Elder Law attorney should be consulted to find out whether spousal refusal or any other options can benefit the well spouse.