How to Handle Post Application Spousal Protection Increases
Table of Contents
Last Updated: May 20, 2026
Introduction
When only one spouse in a married couple applies for Medicaid, which is common, there are financial safeguards in place for the non-applicant spouse, also known as the community spouse. Some spousal protections are updated annually, but the state doesn’t always account for these updates for people already enrolled in Medicaid and their spouses. In fact, we estimate that states fail to accommodate for these updates about 35% of the time. When this happens, community spouses don’t receive the monetary support they are entitled to, and it’s up to the couple or their representatives to notify the state of its mistake.
Medicaid’s Minimum Monthly Maintenance Needs Allowance
The Medicaid spousal protection relevant to this article is the Minimum Monthly Maintenance Needs Allowance (MMMNA). This rule allows the beneficiary spouse to transfer a portion of their monthly income to a low-income community spouse in order to prevent them from living in poverty.
The MMMNA only applies to couples where the beneficiary spouse is enrolled in Nursing Home Medicaid or a Home and Community Based Services (HCBS) Waiver. It does not apply to couples where the beneficiary spouse is enrolled in Aged, Blind and Disabled (ABD) Medicaid, also known as state or regular Medicaid for seniors.
Under MMMNA rules, the community spouse is entitled to a monthly income that matches the MMMNA limit in their state. These limits are based on the Federal Poverty Level (FPL) and in some states, the SSI Federal Benefit Rate (FBR). Since the FPL and FBR are updated and (usually) increased on an annual basis, the MMMNA limits are also updated and (usually) increased annually. These are the increases that are regularly unaccounted for by states and the impetus for this article. We will explain what to do if the state does not factor increased limits into the MMMNA, but it would be helpful to first take a closer look at how the MMMNA works.
Understanding MMMNA Limits
States are allowed to set their own MMMNA limits, but they must be within the minimum and maximum guidelines set by the federal government. The current federally-set minimum in 48 states and Washington, D.C. is $2,643.75 (eff. July 1, 2025 – June 30, 2026). The only exceptions are Alaska and Hawaii, which have their own FPLs and therefore have their own minimum limits – $3,040 for Hawaii and $3,303.75 for Alaska. The current maximum limit in all 50 states and Washington, D.C. is $4,066.50 (eff. Jan. 1, 2026 – Dec. 31, 2026).
Most states use these exact limits, but how they use them can vary. It should also be noted that they are both updated annually, but at different times of the year: July 1 for the minimum guideline and Jan. 1 for the maximum.
Standard Figure
Some states use one “standard figure” as their MMMNA limit. For example, Alabama and North Dakota use the federally-set minimum as their only limit, which means community spouses in those two states are entitled to a monthly income of $2,643.75 (North Dakota rounds up to $2,644).
There are also 14 states that use the federal maximum as their only limit, which means community spouses are entitled to a monthly income of $4,066.50 in the following states: Alaska, California, Georgia, Hawaii, Illinois, Iowa, Louisiana, Mississippi, Nevada, New York, Oklahoma, South Carolina, Texas and Wyoming, as well as Washington, D.C.
Frank and Martha live in Georgia, which uses one standard figure for its MMMNA – $4,066.50/month. Frank has qualified for Nursing Home Medicaid and is moving into a nursing home, while Martha is not covered by Medicaid and will be living at home. Frank has $4,000/month in income while Martha has $1,000/month. Since Martha’s income is $3,066.50 below Georgia’s Minimum MMNA, Frank is allowed to transfer $3,066.50/month to Martha so she can add that to her $1,000/month and reach the Minimum MMNA of $4,066.50/month. It should be noted that the rest of Frank’s income must go to the state to help cover the cost of nursing home care. He’s only allowed to keep a small personal needs allowance, which is $70/month in Georgia.
Minimum and Maximum Figures
All other states use both minimum and maximum figures when determining the MMMNA limit for community spouses. The maximum figure in these states is the federal maximum of $4,066.50 (or $4,077 in states that round up). The minimum figure in all but four of these states is the federal minimum of $2,643.75 (or $2,644 for those that round up). Two of the four exceptions are Alaska and Hawaii, which are mentioned above. The other two exceptions are Wisconsin, which uses a minimum limit of $3,525, and Vermont, which uses a minimum limit of $2,707 and is the only state that updates its minimum limit on Jan. 1 as opposed to July 1.
Community spouses in states that use both minimum and maximum figures are entitled to at least the minimum, and they can be entitled to monthly income all the way up to maximum if their housing and utility expenses justify it. This is determined using the Excess Shelter Allowance, which is $793.13/month (effective July 1, 2025 – June 30, 2026), and the Standard Utility Allowance, which varies by state.
If the total of the community spouse’s monthly housing expenses (such as rent, mortgage, property taxes, homeowner’s or renter’s insurance and utilities) is greater than the $793.13 Excess Shelter Allowance, than the difference is added to the MMMNA limit. While calculating this total, the state’s Standard Utility Allowance (SUA) is used in place of actual utility bills in most cases. Each state sets its own SUA and updates it annually based on average costs of things like cooling, heating, electricity and water in the state.
Ben and Rita live in Pennsylvania, which uses a minimum figure ($2,644/month) and a maximum figure ($4,066.50/month) to calculate the MMMNA. Rita is on Medicaid and will be moving into a nursing home, while Ben is not covered by Medicaid and will be staying at home. Rita has $4,000/month in income and Ben has $1,500/month. Since Ben’s income is under the minimum of $2,644/month, $1,144/month can automatically be transferred from Rita to Ben to meet that minimum ($2,644 – $1,500 = $1,144).
Ben’s shelter costs are $2,400/month, so he can receive another $1,606.87/month thanks to the Excess Shelter Allowance of $793.13 ($2,400 – $793.13 = $1,606.87), bringing the total he can receive from Rita up to $2,750.87/month ($1,444 + $1,606.87 = $2,750.87). However, since Ben’s own income is $1,500/month, he can’t receive the full $2,750.87 because it would put him over the maximum of $4,066.50 ($1,500 + $2,750.87 = $4,250.87), but his MMMNA is that maximum figure, so he can receive $2,566.50/month from Rita to bring him to that $4,066.50 total ($1,500 + $2,566.60 = $4,065.50).
Accounting for MMMNA Increases
As you can see, increases in the MMMNA limits should mean more money for community spouses. But, as mentioned, the state does not account for increases for roughly 1/3 of all couples in this situation, so the community spouses in these couples do not get the monthly income allowance they deserve.
When this happens, the couple and/or their representatives should take the following steps:
1) Request a redetermination: First, they should submit a written request to the local Medicaid caseworker for a “re-budgeting” or “post-eligibility treatment of income” (PETI) review based on the updated MMMNA limits.
2) File for an appeal/fair hearing: If the local Medicaid agency refuses to adjust the budget or ignores the request for a redetermination, the spouse has the right to a fair hearing.
3) Request retroactive adjustment: If the local Medicaid agency failed to account for the annual MMMNA update, the community spouse can demand a retroactive adjustment to recover the underpaid allowance. This often results in a credit or refund from the nursing home because the beneficiary contributed more of their income than was necessary to the nursing home.
Shelter Standard Review
It’s also important for community spouses and/or their representatives to keep track of any changes in the living expenses that are used in the Excess Shelter Allowance calculation (such as rent, mortgage, property tax and insurance), and report those changes to the state. If these living expenses increase, the community spouse’s MMMNA should also increase, but the state will not make this adjustment if they are not notified of the updated expenses.
While the local Medicaid agency may account for the annual increase in the state’s Standard Utility Allowance (SUA), this does not always happen, either. So, to be sure the community spouse is getting what they deserve, it’s also critical for beneficiary couples and/or their representatives to monitor their state’s SUA, which is updated in October in most places.
Renewal Subscription Service
The Medicaid Renewal Subscription Service offered by Eldercare Resource Planning can help community spouse’s receive the income owed to them. As part of this service, our team of professionals will check the state’s math after every MMMNA update to ensure the increases have been accounted for and the community spouse is receiving the income allowance they deserve.
The Renewal Subscription Service is centered around a full, annual review of the subscriber’s finances to ensure they will be found eligible during the yearly Medicaid Renewal process, which states use to determine if beneficiaries are still qualified. If they aren’t, they could lose their coverage and benefits. The service also includes monthly consultations with our team of professionals to deal with any problems as they arise. If there is an issue with the state’s decision regarding Renewal, or the MMMNA, our team will handle all follow-up communication, appeals and fair hearings for subscribers.
