Must an IRA of the not-yet-retired spouse be cashed out and the proceeds spent down in order for the ill spouse to qualify for Medicaid?

If Medicaid required the entire IRA be redeemed and the proceeds spent down, does Medicaid count the before tax (gross amount) or after tax (net) income? I have a very small IRA and am afraid it will have to be cashed out in the future to cover medical costs for my husband who is older.