Does Medicaid Count a Spouse's 401(k) When Determining Eligibility?

That depends on the state. For example, in Massachusetts the answer is "yes" -- 401(k)s and IRAs are counted like any other asset. But in some other states, the spouse’s retirement assets may not be counted. There is one rare exception in Massachusetts: If the spouse is still working and the retirement plan is connected with her employment, then the retirement plan won’t be counted. Given that the rules differ from state to state and that sometimes various exceptions do apply, you will need to consult with a local elder law attorney to be certain. To find one near you, go here: https://www.elderlawanswers.com/USA-elder-law-attorneys.