There are many financial requirements, limits and allowances associated with Medicaid long-term care. Most of these requirements, limits and allowances change annually, but they do so in different months throughout the year. Further complicating the matter is that different states change different figures in different months. For example, Indiana changes their nursing home income limit in January and their ABD income limit in March, while California changes their ABD income limit in April and does not change their nursing home income limit annually at all.

These changes can present problems or opportunities when applying for Medicaid. Knowing in advance when the financial limits will change can help families and industry professionals time their Medicaid applications and plan for their financial future. The table below focuses on when things change, not the current actual limits. For further clarification of the column headers, definitions for the majority of the headers are provided below under the chart and footnotes.

Definitions of Column Headers

1) HCBS Waivers – For seniors and persons with disabilities who require the level of care provided in a nursing home, Home and Community Based Services (HCBS) Waivers provide long-term services and supports in one’s home and / or community. These programs, which limit the number of program participants, are intended to delay and / or prevent the need for institutionalization.

2) ABD Medicaid – The Regular Medicaid program for Aged, Blind and Disabled Persons. While ABD Medicaid is most commonly known for providing program beneficiaries with medical care, states also commonly provide limited long-term care benefits, such as personal care assistance, for persons who have a medical need.

3) Home Equity Limit – For Nursing Home Medicaid and HCBS Waivers, there is a home equity limit if the applicant does not have a spouse, child under 21 years old, or blind or disabled child (of any age) living in their home. Home equity is the home’s fair market value minus any debt against the home, such as a mortgage. If the home is co-owned, it is the applicant’s interest in the home that is calculated towards the home equity limit. For instance, if one’s home equity is $500,000, but they own their home equally with a sibling, their home equity interest is $250,000.

4) Minimum Monthly Maintenance Needs Allowance (Min. MMNA) & Maximum Monthly Maintenance Needs Allowance (Max. MMNA) – Non-applicant spouses of a Nursing Home Medicaid or HCBS Waiver applicant can receive a Monthly Maintenance Needs Allowance (spousal income allowance) from their applicant spouse to cover their basic needs. If a non-applicant’s income falls under the Min. MMNA, they are automatically entitled to income from their applicant spouse (to bring their total income up to the Min. MMNA). The Max. MMNA allows a non-applicant spouse to receive a higher income allowance and is based on one’s shelter and utility costs. The Max. MMNA establishes a cap to the amount of income a non-applicant spouse can receive. Many states utilize a standard MMNA, rather than a Min. and Max. MMNA. In these states, a non-applicant spouse is automatically entitled to income from their applicant spouse, bringing their income up to the standard figure.

5) Minimum Community Spouse Resource Allowance (Min. CSRA) & Maximum Community Spouse Resource Allowance (Max. CSRA) – Non-applicant spouses of a Nursing Home Medicaid or HCBS Waiver applicant are entitled to a Community Spouse Resource Allowance. This allows a non-applicant spouse to retain a greater portion of the couple’s assets. The Min. CSRA is the minimum amount of assets to which a non-applicant spouse is entitled and the Max. CSRA is the cap on the amount of assets that a non-applicant spouse can retain. The non-applicant can keep half of the couple’s assets, up to the Max. CSRA. If their half of the assets falls under the Min. CSRA, they can keep 100% of the assets, up to the Min. CSRA. Not all states utilize both a Min. and Max. CSRA. Instead, some states use a standard figure, and in these states, the non-applicant spouse can automatically keep 100% of the couple’s assets, up to the standard CSRA.

8) Shelter Standard – A federally set figure used by states to determine if a non-applicant spouse is entitled to a greater Monthly Maintenance Needs Allowance. The Shelter Standard is only utilized in states that use both a Min. and Max. MMNA. Essentially, if one’s shelter costs (rent, mortgage, homeowners insurance, utilities) are greater than the Shelter Standard, they may receive a higher MMNA.

9) Standard Utility Allowance – A state-specific figure that is utilized for one’s utility costs. It is added to one’s shelter costs. The Standard Utility Allowance is only utilized in states that use both a Min. and Max. MMNA.