Raising the Spousal Allowances Through a Fair Hearing

When one spouse needs Long-Term Care Medicaid, the spouse at home is protected by two allowances: the Community Spouse Resource Allowance (CSRA), which sets how much of the couple’s assets they keep, and the Minimum Monthly Maintenance Needs Allowance (MMMNA), which sets the minimum income they are guaranteed. Federal law lets either spouse ask for a fair hearing to raise these amounts in certain situations. For couples where the spouse at home has low income, this can protect tens of thousands of dollars more. This guide explains when and how.

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

The two standard allowances

The MMMNA is the minimum figure plus an excess shelter allowance when the spouse’s housing costs (rent or mortgage, taxes, insurance and a utility allowance) exceed a set standard ($811.50 a month from July 1, 2026), up to the maximum. See The MMMNA and The CSRA.

The federal right to a fair hearing

Section 1924 of the Social Security Act gives either spouse the right to a fair hearing about:

• the community spouse monthly income allowance;
• the amount of income treated as available to the spouse at home;
• the computation of the spousal share of resources;
• the attribution of resources;
• the CSRA.

A hearing about the CSRA must be held within 30 days of the request, under federal law.

At the hearing, the allowances can be raised in two main ways.

Way 1: Raising the MMMNA for exceptional circumstances

If either spouse shows that the spouse at home needs income above the MMMNA “due to exceptional circumstances resulting in significant financial duress,” the hearing officer must substitute a higher amount, enough to provide the additional income needed. This can exceed the normal maximum.

Exceptional circumstances are not defined in detail in federal law, and states interpret them differently. Examples that are often considered:

• high medical expenses of the spouse at home not covered by insurance;
• the cost of home care or other support the spouse at home needs because of their own disability;
• unusual housing costs beyond what the shelter allowance covers;
• costs of caring for a dependent family member.

Ordinary expenses, such as a car payment, travel or helping adult children, generally do not qualify.

Way 2: Raising the CSRA to produce income

This is the more common and often more valuable route. If the spouse at home’s income, including the income allowance available from the applicant’s income, is still below the MMMNA, the CSRA can be raised to an amount whose income (for example, interest) would make up the shortfall.

The income-first rule

Federal law requires states to use an income-first approach: the state first counts all of the applicant’s income that could be made available to the spouse at home. Only if a shortfall remains does the state increase the CSRA.

How the increase is calculated

States usually follow these steps:

1. Figure the spouse at home’s MMMNA, including any shelter allowance.
2. Subtract the spouse’s own income.
3. Subtract the income allowance available from the applicant’s income (after the applicant’s personal needs allowance).
4. If there is still a shortfall, figure how much in assets would be needed to produce that much income each month, using an interest rate the state chooses.

Because interest rates on safe investments are usually modest, a small monthly shortfall can justify a large increase in the CSRA. Some states use a fixed rate, some use current market rates, and some use the cost of a single-premium annuity, which produces a smaller increase.

A worked example

Martha and Joe. Joe is in a nursing home. Martha stays at home. Their state uses the half-of-assets rule.

Step 1: Martha’s shortfall before Joe’s income: $2,705 minus $900 = $1,805.

Step 2: Income available from Joe after his allowance: $1,200 minus $50 = $1,150.

Step 3: Remaining shortfall: $1,805 minus $1,150 = $655 a month, or $7,860 a year.

Step 4: If the state uses a 4% interest rate (an example figure), the assets needed to produce $7,860 a year are $7,860 / 0.04 = $196,500.

At a hearing, Martha could ask that her CSRA be raised from $150,000 to $196,500. If the state used a lower rate, the increase would be larger, and could protect the entire $298,000 above Joe’s $2,000 limit.

When it does not help

• If the spouse at home already has income at or above the MMMNA, a CSRA increase on this basis is not available.
• If the applicant’s income alone can bring the spouse up to the MMMNA, the income-first rule means no CSRA increase.
• If assets are already at or below the standard CSRA, there is nothing more to protect.

How to request a hearing

1. Read the notice. The eligibility notice should explain the allowances and the right to a hearing.
2. Request a hearing in writing before the deadline, which is often short.
3. Gather evidence: income statements for both spouses, housing costs, utility bills, medical bills and proof of any exceptional expenses.
4. Prepare calculations showing the shortfall and the CSRA needed.
5. Attend the hearing, often by phone or video. A representative can present the case.
6. Receive the decision in writing.

Some states let the spouse request a higher allowance during the application, without a formal hearing, so ask the caseworker early. Others require the hearing.

Court-ordered support

There is another route. If a court orders the applicant to pay support to the spouse at home, federal law says the income allowance cannot be less than the court-ordered amount, and transfers of resources made under the order for the spouse’s support are not penalized. Some families pursue a support order in family court for this reason. It takes time and legal help.

Common questions

Can the spouse at home request a hearing even after approval? Generally, a hearing is tied to the eligibility decision, and deadlines apply. Ask quickly.

Does raising the CSRA affect the applicant’s eligibility? Yes, positively: more assets are protected, so less must be spent down.

Is there a limit to how much the CSRA can be raised? It is limited by the amount needed to produce the income shortfall and by the couple’s total assets.

What interest rate do states use? It varies. Some use current rates on safe accounts, some a set figure, and some the income an annuity would produce. The rate makes a large difference.

Can we combine this with an annuity? Possibly. An annuity for the spouse at home raises their income, which can reduce or eliminate the shortfall used to raise the CSRA. Planning should compare both approaches.

Getting help

The calculations and evidence for these hearings are technical, and deadlines are short. A Certified Medicaid Planner (CMP) can run the numbers before the application and help the couple decide whether a hearing, an annuity or another strategy protects the most.

Key terms

Evidence checklist

• award letters for Social Security and pensions for both spouses, showing gross amounts;
• the mortgage or rent statement, property tax bill and homeowner’s insurance bill;
• recent utility bills, if the state uses actual costs;
• bills for the spouse at home’s medical care, home care or other exceptional expenses;
• current statements for all countable assets, and the snapshot date figures;
• the eligibility notice and the state’s CSRA and MMMNA calculation.

Organize these with a one-page summary of the numbers. Hearing officers appreciate clear calculations. Bring extra copies for the agency representative, and keep a copy of everything you submit along with the date it was sent.

Related guides

• The CSRA
• The MMMNA
• Spousal impoverishment rules
• Spend-down examples

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