Medicaid law provides special protections for the spouses of Medicaid applicants. These protections ensure that the spouse who is healthy has the financial support they need to continue living in their community. The spouse on Medicaid can then receive long-term care benefits, usually in a nursing home, without bankrupting their spouse.
Medicaid Eligibility for Married Nursing Home Residents
In order to be eligible for Medicaid benefits, a nursing home resident may have no more than $2,000 in countable assets. This amount may be somewhat higher in some states.
If the applicant is married, Medicaid looks at the applicant's countable assets and that of their spouse. Medicaid then adds them together as of the date of the applicant's "institutionalization." This is the date when the applicant enters a hospital or a long-term care facility for a minimum 30-day stay. (It's sometimes called the "snapshot" date because Medicaid is taking a picture of the couple's assets as of this date.)
Community Spouse Resource Allowance (CSRA)
Generally, the spouse who remains at home can keep half of the couple's total countable assets, up to a certain maximum. This healthy spouse (or "community" spouse) can keep up to $148,620 (in 2023).
This "community spouse resource allowance" (CSRA) adjusts each year. It is the maximum amount a state may allow the healthy spouse to retain (without a hearing or a court order). The least that a state may allow a community spouse to retain is $29,724 (in 2023).
For instance, a couple has $100,000 in countable assets on the date the applicant enters a nursing home. The applicant will be eligible for Medicaid once the couple has reduced their assets to a combined figure of $52,000. (That is, $2,000 for the applicant and $50,000 for the community spouse).
Some states, however, are more generous toward the community spouse. In these states, the community spouse may keep up to $148,620 (in 2023) whether or not this represents half the couple's assets.
So, if a couple had $100,000 in countable assets on the "snapshot" date, the community spouse could keep the entire amount. They would not have to limit their assets to half the amount ($50,000).
Income and Eligibility
Fortunately, Medicaid does not count the income of the community spouse in determining the Medicaid applicant’s eligibility. It only counts the income in the applicant’s name.
Imagine a community spouse who still works and earns, say, $5,000 a month. They won't have to contribute toward the costs of care for their spouse who has Medicaid coverage in a nursing home.
In some states, however, the community spouse’s income cannot exceed certain levels. If it does, they do have to contribute toward the care cost for their spouse in long-term care. In these states, the community spouse’s income is not part of the equation when Medicaid is determining eligibility. Yet the community spouse may still be subject to a contribution requirement.
Minimum Monthly Maintenance Needs Allowance (MMMNA)
There are cases where most of the couple's income is in the Medicaid applicant's name. As a result, the community spouse may not have enough income to continue living on their own. In such cases, the community spouse can in fact keep some or all of their nursing home spouse's monthly income.
The amount of income the community spouse can retain depends on the Medicaid agency. State Medicaid agencies determine the minimum income level – or minimum monthly maintenance needs allowance (MMMNA) – for the community spouse. The Medicaid agency uses a complicated formula to calculate this allowance for community spouses, based on their housing costs.
The MMMNA may range from a low of $2,288.75 to a high of $3,715.50 a month (in 2023). If the community spouse's own income falls below their MMMNA, the nursing home spouse's income covers the shortfall.
For example, Jason Smith and his wife, Samantha Brown, have a joint income of $3,000 a month. Mr. Smith has $1,700 in his name, while Ms. Brown has $700 in her name.
Mr. Smith enters a nursing home and applies for Medicaid. The Medicaid agency determines that Ms. Brown's MMMNA is $2,300 (based on her housing costs). The Medicaid agency allocates $1,500 of Mr. Smith's income to support her, since her own monthly income totals only $700.
Mr. Smith also may keep a $60-a-month personal needs allowance. So, his obligation to pay the nursing home is only $140 a month ($1,700 - $1,500 - $60 = $140).
In exceptional circumstances, community spouses may seek an increase in their MMMNA. They can either appeal to the state Medicaid agency or obtain a court order of spousal support.
Consult an Elder Law Attorney
If you are applying for Medicaid long-term care benefits, learn more about how to ensure your spouse has sufficient income. A qualified elder law attorney near you can offer guidance.
Find out how much your state allows community spouses to retain. Visit the "State Medicaid Information" webpage and click on the state where you live.