Spend-Down Examples for Singles and Couples

The rules for the Long-Term Care Medicaid spend-down make more sense when you see them applied to real situations. This guide walks through several examples, for single people and for married couples, in different kinds of states. The people and some figures are made up for illustration, but the federal figures used are the 2026 amounts, and each example follows the general rules. Your state’s figures may differ, so check its state guide.

Figures change periodically. Double-check current amounts before relying on them.

How to read these examples

Each example shows:

• the starting assets and income;
• what is exempt;
• the excess that must be spent down or protected;
• the plan;
• the result.

The federal 2026 figures used are: CSRA minimum $32,532 and maximum $162,660; MMMNA minimum $2,705 (from July 1, 2026); special income limit $2,982 a month; and an asset limit of $2,000 for a single applicant where the state uses the SSI limit.

Example 1: single, modest savings

Rita, 88, widowed, entering a nursing home in a state with a $2,000 limit.

Excess: $22,000 minus $2,000 = $20,000.

Plan:

• Irrevocable funeral contract: $8,500.
• Dental work and new glasses: $3,000.
• Clothing, a TV and a recliner for her room: $1,800.
• The rest goes to private pay at the nursing home for about one month.

Result: Rita is eligible within about six weeks. Her income, minus her personal needs allowance, goes to the nursing home each month.

Example 2: single, larger estate, with a home

Harold, 84, single, in a nursing home. His daughter lives nearby.

Excess: $238,000.

Plan options (with a CMP):

• Pay privately for care while planning.
• Prepay funeral, repair the home.
• Consider whether a planned gift combined with an annuity or other strategy could reduce the total cost of care, given his state’s penalty divisor. This must follow federal rules exactly.
• Plan for the IRA withdrawal tax.

Result: Without planning, Harold would spend almost all of his savings on care before qualifying. With planning, part may be preserved, depending on state rules. The home remains exempt but may be subject to estate recovery after his death.

Example 3: married, half-of-assets state

Joan and Paul. Paul, 83, enters a nursing home. Joan, 79, stays home. Their state uses the half-of-assets rule.

CSRA: Half of $180,000 = $90,000 (between the minimum and maximum).

Excess: $180,000 minus $90,000 (Joan) minus $2,000 (Paul) = $88,000.

Plan:

• Replace the 15-year-old car with a reliable used car for Joan: $22,000.
• New roof and furnace on the home: $18,000.
• Two irrevocable funeral contracts: $16,000.
• Hearing aids for Paul and dental work for Joan: $7,000.
• Pay off the remaining home equity loan: $10,000.
• The remaining $15,000 is spent on Paul’s care.

Income: Paul has $2,300 a month. Joan has $1,200. Her MMMNA is at least $2,705, so up to $1,505 of Paul’s income can be paid to her (more if her housing costs are high).

Result: Paul qualifies. Joan keeps $90,000, the home, a reliable car and an income of at least $2,705 a month.

Example 4: married, full-amount state

Same couple, but their state lets the spouse at home keep the maximum.

CSRA: $162,660 (the 2026 maximum, since their assets exceed it).

Excess: $180,000 minus $162,660 minus $2,000 = $15,340.

Plan: Prepay both funerals and pay for a few weeks of care.

Result: Paul qualifies quickly. Joan keeps $162,660. The state makes an enormous difference.

Example 5: married, spouse’s income is low

Lena and Victor. Victor needs nursing home care. Lena has only $700 a month in Social Security. Victor has $1,500. They have $250,000 in countable assets in a half-of-assets state.

• CSRA: Half is $125,000.
• Income: Lena’s MMMNA is at least $2,705. Even with all of Victor’s income available to her after his personal needs allowance, she would still be short.
• Raising the CSRA: At a fair hearing, they can ask that more assets be protected, enough to generate the missing income. Under the “income first” rule, Victor’s available income is counted first.

Result: Lena may be able to keep much more than $125,000. See Raising the spousal allowances.

Example 6: both spouses need care

Ruth and Sam both need nursing home care. They have $40,000 in countable assets. Their state’s limit for a couple who both apply is $3,000.

Excess: $37,000.

Plan: Funeral contracts for both, needed items, and private pay.

Result: No CSRA, because neither is a spouse at home. Once both are in a facility, some states treat them as individuals after a period, each with their own limit. See When both spouses need care.

Example 7: income over the cap

Clara, 90, single, income cap state, $3,300 a month in income and $5,000 in savings.

• Income: Over $2,982. A Qualified Income Trust is set up, and $400 a month or more is deposited each month.
• Assets: $3,000 is spent on a hospital bed for her room and clothing.

Result: Clara qualifies. The QIT funds go to her care each month.

Lessons from the examples

• The state’s rules matter enormously, especially for couples.
• Married couples have far more room to protect assets and income.
• Spending on exempt assets (cars, homes, funerals) converts countable money into protected value.
• Taxes and timing can change the best plan.
• Larger estates benefit most from professional planning. A Certified Medicaid Planner (CMP) can model the options.

Common questions

Are these examples real? They are illustrations based on common situations, using 2026 federal figures. They are not advice for any particular family.

Why does Example 4 protect so much more than Example 3? Because the state lets the spouse at home keep the maximum CSRA rather than half.

Can a single person protect anything? Through exempt assets and some legal strategies, yes, but much less than a married couple.

Example 8: income spend-down at home

Walt, 77, lives at home in a medically needy state. He has $1,700 a month in income. His state’s medically needy income level is $1,000 (an example figure), so his monthly spend-down is $700.

• His Medicare Part B premium is $202.90 and his Medigap premium is $210. Those alone count $412.90 toward the spend-down.
• His prescriptions and home care costs add another $350 in a typical month.
• He meets the spend-down most months, and Medicaid then covers the rest of his eligible care.

Result: Walt keeps $1,000 a month to live on plus whatever he does not spend on medical bills, and has Medicaid most months. In a month with fewer bills, he may not qualify. He asks the state about a pay-in option for steadier coverage.

Example 9: an inheritance after approval

Dolores, 86, is on nursing home Medicaid. Her brother dies and leaves her $30,000.

• The inheritance counts as income in the month received and as an asset after that.
• Dolores must report it promptly.
• Her family uses it for an irrevocable funeral contract, personal items and private pay for the months she is over the limit, then she reapplies or continues coverage.

Result: Dolores loses coverage briefly but regains it. Had her brother left the money in a supplemental needs trust for her, it might not have affected her eligibility. See Receiving an inheritance.

Mistakes the examples avoid

• No gifts to family were used as a spend-down.
• Every purchase benefited the applicant or the spouse.
• Records were kept for each step.
• The application was filed when assets were under the limit on the testing date.

Putting your own numbers in

To build your own rough estimate, start with the same steps used above:

1. List countable assets as of the first of the month.
2. Subtract exempt items.
3. For a married couple, figure the spouse at home’s CSRA under your state’s rule.
4. Subtract the applicant’s asset limit.
5. Whatever remains is the amount to spend down or plan for.

Then list the purchases that would genuinely help the applicant or spouse, add their cost, and see how much would go to care. This is only an estimate. A CMP can test it against your state’s rules before you act.

Related guides

• How the spend-down works
• Allowed and not-allowed purchases
• The CSRA
• The MMMNA

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.