Introduction
When only one spouse in a married couple applies for Medicaid long-term care, there are rules that support the non-applicant spouse, also known as the community spouse. Their homes and income are protected, and community spouses are allowed to keep assets well beyond the eligibility limit the applicant spouse must meet in order to qualify for Medicaid. Calculating the various spousal protections can be so complex even state Medicaid agencies get them wrong, so consulting with a planning professional is strongly advised for married couples in this situation.

Spousal Protections for Income

When both spouses in a married couple are applying for Medicaid long-term care, they both have to meet an income limit, which is $2,901/month per spouse (or $5,802/month combined) in most states in 2025. However, when only one spouse in a married couple is applying for Nursing Home Medicaid or Home and Community Based Services (HCBS) Waivers, the income of the community spouse is not counted. The applicant still has to meet the individual income limit, which is $2,901/month in most states in 2025, but the community spouse can have any amount of income.

This rule does not apply to regular state Medicaid, also known as Aged, Blind and Disabled (ABD) Medicaid. The income of both spouses is counted for married ABD Medicaid applicants whether it’s one or two spouses applying.

To find the exact income limit for your situation, as well as other eligibility criteria, use this Medicaid Eligibility Requirements Finder tool.

Monthly Maintenance Needs Allowance

There’s also a Medicaid provision that supports low-income community spouses – the Monthly Maintenance Needs Allowance (MMNA). Community spouses are entitled to have income that matches their state’s MMNA. If they don’t, the applicant/beneficiary spouse can transfer some or all of their income to the community spouse until they do reach the MMNA. It’s important to note that the MMNA only applies to Nursing Home Medicaid and HCBS Waivers. It does not apply to ABD Medicaid.

A state’s MMNA must fall between federal government standards that are updated annually. The Minimum MMNA is $2,555 (effective July 1, 2024 – June 30, 2025) in 48 states and Washington, D.C. The two exceptions are Hawaii ($2,937.50) and Alaska ($3,192.50). The Maximum MMNA in all 50 states and Washington, D.C., is $3,948 (effective Jan. 1, 2025 – Dec. 31, 2025).

Thanks to the MMNA, applicant/beneficiary spouses can actually keep income above their normal eligibility limit, which is $2,901/month in most states in 2025. They are allowed to do this so they can have enough income to transfer to the community spouse. For example, Bill is applying for Medicaid in a state with a $2,901/month income limit, but his income is $4,000/month. However, his wife Jane has just $1,000/month income and the state’s MMNA is $3,948. This means Bill can transfer up $2,948/month of income to Jane. When he makes the transfer, his countable income of $4,000/month will be reduced by $2,948, bringing it down to $1,052/month, which is well below the income limit. So, Bill can qualify for Medicaid and Jane can have more income.

What counts as income for one spouse but not for another can fall into gray areas, and it can also change depending on the state. This is just one reason calculating the MMNA is difficult. At Eldercare Resource Planning, our team of professionals has the education and experience to make these calculations correctly, and to double check the MMNA total offered by the state. Some state agencies are reliably accurate in these areas while others are often inaccurate, but in general, our planning professionals have found that the state is wrong more than half of the time when it comes to calculating the MMNA.

Shelter Costs

There are 14 states that currently use $3,948 as their standard MMNA, like in the example above. There are 33 states that use both a Minimum and a Maximum MMNA. In these states, all community spouses are entitled to have a monthly income that matches the Minimum MMNA, which is $2,555 in most states in 2025. They may be entitled to more, up to the Maximum of $3,948, if their shelter costs justify it. Shelter costs can include expenses like rent, mortgage, utilities, property tax and homeowner’s or renter’s insurance.

If the shelter costs exceed $766.50/month, the difference is added to the Minimum MMNA. For example, if the community spouse’s shelter costs are $950/month, they would be entitled to an extra $185.50/month ($950 – $766.50 = $185.50), bringing their MMNA to $2,740.50/month ($185.50 + $2,555 = $2,740.50). To be clear, $766.50 is the Monthly Housing Allowance that’s pre-set by the federal government and updated annually on July 1.

What does and does not constitute a shelter cost can also fall into some gray areas. This is another reason for seniors to seek professional help before utilizing the MMNA.

Spousal Protections for Assets

As a general rule, Medicaid considers the assets of married couples to be jointly owned. When both spouses are applying for Medicaid long-term care, the asset limit in most states in 2025 is a combined $3,000 or $4,000. However, when only one spouse is applying for Medicaid, the community spouse is allowed to keep up to $157,920 in assets (as of 2025 and depending on the state and the couple’s financial situation). This is known as the Community Spouse Resource Allowance (CSRA).

The federal government sets guidelines for the CSRA, like it does with the MMNA discussed above. These guidelines are updated annually on Jan. 1, and for 2025 the maximum CSRA is $157,920 and the minimum is $31,584.

Also like the MMNA, the CSRA only applies to Nursing Home Medicaid or Home and Community Based Services Waivers. It does not apply to Aged, Blind and Disabled Medicaid.

Calculating the Community Spouse Resource Allowance

The first step in calculating the CSRA is totaling up the value of the couple’s countable assets. Most assets are counted toward Medicaid’s asset limit, but not all. Some are exempt, including a primary home (discussed more below), a primary vehicle, furniture, appliances and personal items like clothes and wedding rings.

The next step depends on the state. In many of them, known as 50% states, the total of the couple’s assets is divided in half, and that number is how much of the couple’s assets the community spouse is entitled to keep via the CSRA, as long as it’s below the state’s CSRA limit. In 100% states, the community spouse is allowed to keep all of the couple’s assets, up to the state’s CSRA limit. In most states, the CSRA limit is the maximum allowed by the federal government, ($157,920 as of 2025), but that’s not the case in every state. In South Carolina, for example, the CSRA limit is currently $66,480.

Calculating the CSRA can be nuanced, like the MMNA discussed above. Which assets are counted and which are exempt isn’t always clear, especially for anyone with complex financial holdings. Again, some state agencies are typically accurate when it comes to determining the amount of any CSRA, but in general we have found that states miscalculate the CSRA 75% of the time or more. Medicaid Planning professionals, like our team of experts at Eldercare Resource Planning, can quickly spot those mistakes and make sure their clients end up with the benefits they deserve.

Spousal Home Protections

If the primary home was counted toward the asset limit, most homeowners would not be able to qualify for Medicaid. However, there are many scenarios that make a home exempt from the asset limit.

What’s more, the home is also protected from Medicaid Estate Recovery if the spouse is living there. All states are required to try and collect reimbursement for Medicaid expenses after the death of the beneficiary, and this process is known as Medicaid Estate Recovery. States will force the sale of the home to collect reimbursement, but not if the community spouse is still living there.

Most states will not even attempt recovery via the house even after the death of the community spouse. But there are some states, known as expanded recovery states, that might try to collect reimbursement for Medicaid expenses via the house after the death of the community spouse. These states may even place a lien on the home while the community spouse is living there to make sure it is not sold without the state getting paid back for its Medicaid expenses.

To learn more about the estate recovery laws in your state, and to ensure a community spouse is getting all the support they deserve, contact a Medicaid Planning professional.