Spousal impoverishment rules let a married Medicaid applicant enter a nursing home or certain home-based programs without forcing the at-home spouse to spend down to poverty. Federal law sets a Community Spouse Resource Allowance (CSRA) between $32,532 and $162,660 for 2026, plus a Minimum Monthly Maintenance Needs Allowance (MMMNA) income floor states may set up to $4,066.50 per month. The institutionalized spouse still faces a $2,000 countable asset cap in most states. County workers apply these figures at the first month of eligibility, not on every grocery receipt.
Congress wrote spousal impoverishment rules into the Social Security Act after families complained that a nursing home admission wiped out the spouse who still paid rent and bought groceries. Section 1924 of the Act, codified at 42 U.S.C. 1396r-5, splits a married couple into two eligibility units when one spouse needs Medicaid long-term care and the other stays in the community.
The rules address two fears at once. First, the community spouse should not lose every CD and brokerage account to reach the applicant's $2,000 resource cap. Second, the community spouse should not live on pocket change while the facility spouse keeps a Social Security check that could cover heat and prescriptions.
Margaret in Columbus watched her husband Harold enter a Franklin County nursing home in March 2026. Ohio JFS counted their joint checking, two IRAs, and a non-exempt lake lot. Without spousal protections, Harold would have had to spend nearly everything down to $2,000. Instead, Margaret kept a CSRA share near $98,000 while Harold retained $2,000 in his name.
These protections do not apply to every Medicaid category. They attach to nursing facility care, certain 1915(c) waiver slots, and other long-term services and supports that states elect to cover. They do not shield a couple when both spouses apply from home with no institutional admission on the file.
Common mistake:Assuming spousal rules apply to regular community Medicaid for both spouses. If neither spouse enters a nursing home or qualifying waiver program, counties use the standard couple asset test, often $3,000 combined in SSI-linked states. Ask the eligibility worker which program code they will use before you move money.
The CSRA is the countable asset share the community spouse may keep while the institutionalized spouse qualifies for Medicaid. CMS publishes updated brackets each January based on the Consumer Price Index. For 2026, the federal minimum CSRA is $32,532 and the maximum is $162,660.
Workers total every countable asset owned by either spouse on the snapshot date. They include bank balances, brokerage accounts, non-exempt real estate, and revocable trust principal. They exclude items listed in our medicaid exempt assets guide, such as a primary home when a spouse still lives there.
The standard formula takes half of the combined countable total. That number cannot fall below $32,532 or rise above $162,660 unless a court or fair hearing orders a different figure. The applicant may keep $2,000 in countable assets on top of the spouse's protected share in most nursing home cases.
| Measure | 2026 federal figure | Who it applies to |
|---|---|---|
| CSRA minimum | $32,532 | Community spouse floor when half of assets is lower |
| CSRA maximum | $162,660 | Community spouse ceiling when half of assets is higher |
| Applicant resource limit | $2,000 | Institutionalized spouse countable cap in most states |
| Couple limit (both applying from community) | $3,000 | When neither spouse uses spousal impoverishment rules |
| Home equity cap (federal minimum) | $752,000 | Countable equity if no exempt resident lives in the home |
Rosa and Luis Delgado live in a paid-off bungalow in Tampa's Seminole Heights neighborhood. Luis fractured his hip in January 2026 and moved into a Hillsborough County skilled nursing facility. Rosa stays in the house and handles bills on a fixed pension.
Their countable assets include $84,000 in Luis's IRA, $62,000 in a SunTrust joint account, $48,000 in Rosa's credit union CDs, and a $20,000 lot in Polk County they never built on. The total is $214,000. The homestead is exempt because Rosa still lives there.
Florida DCF runs the CSRA math on $214,000. Half equals $107,000. That sits between the $32,532 floor and the $162,660 ceiling, so Rosa's CSRA is $107,000. Luis may keep $2,000 in countable assets. Together they may retain $109,000 before spend-down.
The raw spend-down gap is $105,000 ($214,000 minus $109,000). Rosa cannot simply gift the difference to their daughter. A $40,000 transfer twelve months ago could trigger a DCF penalty even after the CSRA split. Rosa should pay legitimate debt, buy exempt items, and fund Luis's care invoices through allowed channels described in medicaid spend down strategies.
You can model similar math on our florida calculator page. Enter $214,000 as household countable assets with one spouse applying to see how DCF treats the CSRA bracket.
Assets tell only half the story. The MMMNA sets a monthly income floor for the community spouse. If the community spouse's own income falls below the state's MMMNA, Medicaid may shift income from the facility spouse up to that threshold.
CMS sets a federal range each year. For 2026, the maximum MMMNA is $4,066.50 per month effective January 1. The minimum MMMNA rises to $2,705.00 on July 1, 2026, for most states. Alaska and Hawaii publish higher poverty-linked figures.
States choose a single MMMNA inside that band. California DHCS posted $4,067 for 2026. Ohio and Michigan often track the federal maximum, but you must confirm the figure on your approval notice. Workers subtract Medicare Part B premiums and certain health insurance costs before they compare income to the MMMNA.
Suppose Rosa's pension and Social Security total $2,180 per month after Medicare deductions. Luis receives $2,640 from Social Security and a small annuity. Florida could allocate up to $1,886.50 of Luis's income to Rosa so her total reaches the state MMMNA, if Florida uses the federal maximum. Luis would then owe a patient liability to the nursing home from what remains.
Income caps still matter. Florida nursing home applicants above $2,982 monthly gross income may need a Qualified Income Trust even when the CSRA math passes. Read medicaid income limits spend down for how income tests differ from asset tests.
Federal law requires states to use spousal impoverishment rules for nursing facility residents. States may also extend the same protections to Home and Community Based Services (HCBS) waivers. Pennsylvania covers spouse protections on certain waiver programs. Texas applies them in nursing home and some waiver paths handled by HHSC.
The protections start in the first month the institutionalized spouse is eligible for Medicaid long-term care, or when the state determines the need for that level of care. Retroactive coverage can pull asset snapshots back three months in many states, so bank balances on those dates still count.
Diane in Austin entered a Travis County memory care unit in May 2026. Texas HHSC ran spousal impoverishment because her husband Paul stayed in their condo. If Diane had only applied for regular adult Medicaid with no long-term care component, the couple would have faced the standard $3,000 asset cap instead.
Same-sex married couples and registered domestic partners receive the same federal protections where state law recognizes the relationship. California explicitly includes registered domestic partners in Medi-Cal spousal impoverishment policy letters.
Common mistake:Filing for regular Medicaid drug coverage while your spouse sits in a nursing home. Tell the worker you need long-term care spousal impoverishment rules on the application. The wrong program code can deny the CSRA entirely.
Eligibility specialists follow the same worksheet skeleton nationwide, even when state portals look different. Understanding the steps helps you catch errors before money moves.
Step one lists countable assets for both spouses on the snapshot date. Step two adds the totals. Step three divides by two. Step four compares the result to the federal floor and ceiling. Step five assigns the CSRA to the community spouse and $2,000 to the applicant unless state rules vary.
After the CSRA is set, excess countable assets must leave the applicant's control through spend-down or transfer to the community spouse. Some states grant a short window to retitle accounts without treating the move as a disqualifying gift.
California's ACWDL 26-02 describes a 90-day CSRA transfer period starting the month of initial spousal impoverishment eligibility. During that window, excess property in the institutionalized spouse's name may shift to the community spouse without a penalty if done correctly.
Other states expect the division before or at application. New York OTDA workers in Erie County often want the community spouse's name on the protected share before they close the case. Pennsylvania DHS may accept a signed plan with deadlines.
Transfers to adult children still face the five-year look-back. Retitling from husband to wife inside the CSRA plan is different from gifting $50,000 to a son. The first follows federal spousal rules. The second can impose months of ineligibility.
Spousal impoverishment rules do not erase other Medicaid requirements. They layer on top of asset limits, income caps, level-of-care reviews, and estate recovery notices.
Exempt assets never enter the CSRA numerator. Rosa's Tampa homestead stays off the worksheet while she lives there. A second car, extra burial contracts, or prepaid funerals may count or qualify depending on state caps. Our medicaid exempt assets guide lists the usual categories.
Spend-down channels still matter. After the CSRA split, the applicant must reduce remaining countable assets through allowable spending. Paying credit card debt, buying a new hearing aid, or prepaying medical bills can work. Gifting does not.
Couples with $380,000 in countable assets hit the CSRA ceiling. Half would be $190,000, but the community spouse keeps only $162,660. The applicant keeps $2,000. The spend-down gap is $215,340 before exemptions. High-asset families in new york calculator territory face the same federal cap even when local income rules differ.
If you are new to Medicaid spend-down overall, start with what is medicaid spend down for the medically needy pathway and how it differs from nursing home resource tests.
Federal law sets the CSRA ceiling and MMMNA band, but state Medicaid agencies run the desks where papers land. Florida DCF uses ACCESS sites in Hillsborough and Miami-Dade. Ohio JFS handles Franklin and Cuyahoga counties. Texas HHSC routes through managed care organizations in urban counties. Pennsylvania DHS and Michigan MDHHS publish different burial fund caps on their asset worksheets.
New York adds estate recovery and income planning layers OTDA workers explain at intake. Some states apply spousal rules to HCBS waivers while others limit protections to nursing homes. Always read the state calculator page before you assume your county follows Florida's 90-day transfer window.
Our ohio calculator tool uses Ohio's $2,000 applicant cap with the 2026 CSRA bracket. The texas calculator page reflects HHSC nursing facility limits. pennsylvania calculator and michigan calculator include local agency names and verified resource figures where posted.
Asset limits for regular Medicaid expanded in some states during recent federal waivers, then snapped back. California restored countable asset tests on January 1, 2026, for certain Non-MAGI groups while keeping spousal impoverishment protections for nursing home cases. Your approval notice beats any blog post.
Common mistake:Using last year's CSRA chart for a 2026 filing. CMS raised the maximum from prior-year levels to $162,660. Counties will not apply old caps because you printed the wrong PDF.
Our state calculators run the CSRA formula against the household countable total you enter. They apply the $32,532 floor and $162,660 ceiling, then add the $2,000 applicant share. The Tampa $214,000 example produces a $105,000 spend-down gap on the florida calculator page when you mark one spouse as applying.
The tools do not calculate MMMNA income shifts, Qualified Income Trust deposits, or patient liability after approval. They do not know whether your second home in the Poconos is exempt under Pennsylvania rules. They flag look-back risk only when you enter gift amounts.
Use the calculator to test scenarios before you meet an attorney. Bring the printed output to your DCF, JFS, or HHSC appointment so you can ask whether your exempt assets list matches theirs. Pair results with CSRA 2026 math and asset protection for couples when you model retitling accounts.
CMS set the 2026 federal maximum Community Spouse Resource Allowance at $162,660 effective January 1, 2026. If half of your combined countable assets exceeds that figure, the community spouse still keeps only $162,660 unless a court or fair hearing orders more.
The federal maximum MMMNA is $4,066.50 per month in 2026. The federal minimum rises to $2,705.00 on July 1, 2026, in most states. Each state picks its own figure inside that range, so check your approval notice for the exact dollar amount.
No. The community spouse keeps the CSRA share, exempt assets like a primary home, and possibly an income allocation up to the MMMNA. The applicant may keep only $2,000 in countable assets in standard nursing home rules. Remaining countable assets must be spent down or transferred under a valid plan.
Most states set the CSRA only at the first month of spousal impoverishment eligibility. After that, assets titled solely in the community spouse's name often stop counting against the applicant. California DHCS confirmed this renewal policy in ACWDL 26-02. Other states may still ask for income updates.
Florida DCF applies federal CSRA brackets to nursing home and SMMC Long Term Care cases. The community spouse keeps between $32,532 and $162,660 of countable assets in 2026, depending on half of the couple's total. Nursing home applicants above $2,982 monthly gross income may still need a Qualified Income Trust. Use our Florida calculator for asset math.
Half of $325,000 is $162,500, which sits just under the 2026 federal cap. At $330,000, half would be $165,000, so the CSRA hits the $162,660 ceiling. The applicant keeps $2,000. Everything above roughly $164,660 must be spent down through allowed channels or converted to exempt assets.
Transfers between spouses for CSRA planning inside the eligibility window are generally treated differently from gifts to children. Moving funds to qualify under spousal impoverishment rules follows federal guidance. Gifts to third parties during the five-year look-back can still trigger penalty months in every state.
Start with the CMS informational bulletin published April 27, 2026, and the Medicaid.gov spousal impoverishment page. Then call your county Medicaid office. Florida families dial ACCESS at (877) 254-1055. Ohio residents contact their county Department of Job and Family Services.
