How does the Missouri Medicaid office look at the community spouse's 401k accounts if the other spouse needs to go to a nursing home or assisted living?

Get yourself an application, even if you are not ready to apply. You will see what kinds of things you have to report. Generally all assets of both spouses are counted. Remember that a married couple has a much higher limit than you may have seen for a single person. The intention is not to impoverish the community spouse.

You can print out the application form, study it, and then at least have specific questions and refer to parts of the application that you don't understand. If you are going to consult an Elder Law attorney, fine, but study the application first to streamline the appointment

You can print it out from here: http://dss.mo.gov/fsd/formsmanual/pdf/im1ma.pdf

Contact An Elder Law Attorney In Your State For A Consultation.