Spousal Impoverishment Rules
What Are Medicaid Spousal Impoverishment Rules?
Spousal Impoverishment Rules are federal Medicaid protections designed to prevent the spouse of a Medicaid applicant from becoming financially destitute when the other spouse needs long-term care. These rules were established in 1988 to ensure that the “community spouse” (the non-applicant spouse) can keep enough income and assets to support themselves while their partner qualifies for Medicaid coverage.
They work by setting aside a portion of a couple’s income and resources for the non-applicant spouse, including protections for the primary home.
Common alternate terms for these rules include Special Income Rules, Income Protections, and Asset Protections. The spouse applying for Medicaid is often called the Institutionalized Spouse, while the non-applicant is referred to as the Community Spouse or Healthy Spouse.
Who Do These Rules Apply To and When?
Originally, spousal impoverishment protections only applied to spouses of Nursing Home Medicaid applicants. Since 2014, they have also applied to spouses of applicants for Home and Community Based Services (HCBS) Waivers. This expansion is currently in effect through September 2027 under the Omnibus Appropriations Bill.
Without these protections, couples might have to deplete most of their income and assets to pay for care before Medicaid eligibility is possible, which can force premature nursing home placement. These rules do not apply to Regular Medicaid (Aged, Blind, and Disabled Medicaid) for community-based medical coverage.
What Are the Two Main Parts of Spousal Protections?
There are two key financial protections for the community spouse:
- Minimum Monthly Maintenance Needs Allowance (MMMNA) – Protects a portion of the couple’s income.
- Community Spouse Resource Allowance (CSRA) – Protects a portion of the couple’s countable assets.
There are also additional home protections that apply to married couples when only one spouse applies for Medicaid.
How Does the Minimum Monthly Maintenance Needs Allowance (MMMNA) Work?
If the community spouse’s income is below a state-set minimum, they are entitled to receive income from the applicant spouse to bring them up to the MMMNA. This ensures the non-applicant spouse has a basic income to cover living expenses. The federal government updates the minimum and maximum MMMNA amounts each year.
Some states allow a higher allowance based on actual shelter costs (mortgage/rent, utilities, insurance). Alaska and Hawaii have different MMMNA amounts due to unique federal poverty level calculations.
What Is the Community Spouse Resource Allowance (CSRA)?
The CSRA protects a set portion of a couple’s countable assets for the community spouse. While the Medicaid applicant must meet a strict asset limit (often $2,000), the community spouse can keep much more—within federal minimum and maximum limits, which adjust annually.
Exempt assets (not counted toward the limit) typically include the primary home, household items, personal belongings, and one vehicle. Couples over the limit must “spend down” assets—often on home modifications, prepaid burial arrangements, or Medicaid-compliant annuities—to qualify without violating Medicaid’s look-back rules.
How Is the Primary Home Protected?
The family home is almost always exempt from the asset limit if the community spouse lives in it, regardless of equity value. Vacation or secondary properties, however, are countable assets.
For single applicants, the home can also be protected if they intend to return, but an equity limit applies. States use federally set minimum or maximum equity limits (or something in between) when determining eligibility.
What Are the 2025 Federal Spousal Impoverishment Figures?
- Minimum MMMNA (July 2025 – June 2026): $2,643.75 (Lower 48), $3,303.75 (Alaska), $3,040.00 (Hawaii)
- Maximum MMMNA (Jan – Dec 2025): $3,948
- Minimum CSRA (Jan – Dec 2025): $31,584
- Maximum CSRA (Jan – Dec 2025): $157,920
- Minimum Home Equity Limit (Jan – Dec 2025): $730,000
- Maximum Home Equity Limit (Jan – Dec 2025): $1,091,000
Most states use these federal limits, though some adopt their own within the federal range.
Why Is Professional Planning Important?
Because these rules interact with Medicaid’s strict eligibility criteria and look-back period, professional Medicaid planning is recommended. An experienced planner can help a couple protect the maximum allowable income and assets while ensuring eligibility for care—without costly mistakes that could lead to penalties.
