Currently, both members of a couple do not have to become impoverished for one to received long-term services and supports through Medicaid. This protection does not apply if the spouse needing care is not institutionalized. With the enactment of the Affordable Care Act (ACA), for five years beginning in 2014, states are required to extend the same spousal impoverishment protections that apply to institutional care to home- and community-based care.