How Medicaid Long Term Care Eligibility is Impacted by Marital Status

Summary
Whether your married or single, otherwise known as your marital status, can impact your Medicaid Long Term Care eligibility criteria. Single individuals have more restrictive financial limits, while married couples are permitted more generous limits in order to allow a spouse to continue living independently. It can be further complicated by other factors, such as age, state of residence, type of Medicaid and whether or not your spouse is also applying for Medicaid.

 

Why and How Eligibility Criteria Vary with Marital Status

To understand how and why eligibility criteria varies with marital status, one must first understand the three types of Medicaid Long Term Care and the locations in which care is provided.

1. Nursing Home Medicaid – is provided only in a nursing home and Nursing Home Medicaid recipients must pay almost all of their monthly income to Medicaid.
2. Home and Community Based Services (HCBS) Medicaid Waivers – are provided to beneficiaries in their homes or somewhere else in the “community,” such as the home of a loved one or an assisted living residences. HCBS Waivers recipients are permitted to retain their income to pay for their housing costs.
3. Aged, Blind and Disabled (ABD) Medicaid – is provided at home or elsewhere in the community, such as the home of a loved or an assisted living facility, and provides a lower level of support than waivers. ABD Medicaid recipients are permitted to retain their income for their housing costs, but income limits are lower than with they are for Nursing Home Medicaid or HCBS Waivers.

Medicaid has different financial criteria for single and married applicants to allow a healthy spouse to continue living independently when a spouse that requires care enters a nursing home. Otherwise, since spouses typically share assets and income, and a spouse entering a nursing home must have limited assets to qualify for Nursing Home Medicaid and must surrender almost all of their income to the nursing home, a healthy spouse might have no money on which to live.

This is referred to as “spousal protection.” These protections change depending on which of the three  Medicaid Long Term Care programs covers you, since that will impact where you live. You could live at-home, in assisted living or in a nursing home, and as your residence changes the living expenses for you and your spouse will also change.

 

Understanding Medicaid's Spousal Protections

A key component to understanding how marital status relates to Medicaid eligibility is knowing the spousal protection rules, which are also known as spousal impoverishment rules. While these rules may not impact the applicant’s eligibility directly, they can play a role in how couples strategize and prepare their finances. Spousal protection regulations help prevent non-applicant spouses, also known as community spouses from going into poverty, while also ensuring that the applicant/beneficiary spouse meets the criteria for coverage.

The two most important spousal protection rules are the Monthly Maintenance Needs Allowance and the Community Spouse Resource Allowance, and we will detail both of these in the next two sections.

Monthly Maintenance Needs Allowance (MMNA)

If the community spouse has income below the state Monthly Maintenance Needs Allowance (MMNA) limit, the applicant/beneficiary spouse can transfer as much of their income as is necessary to push the community spouse’s income up to the state’s MMNA limit. This limit ranges from $2,555 – $3,853.50/month as of July 1, 2024, depending on the state and the community spouse’s income and living expenses. The transferred income does not count toward the income limit of the applicant/beneficiary spouse.

It’s important to note that the MMNA only applies to Nursing Home Medicaid and Home and Community Based Services (HCBS) Waivers applicants and recipients. The MMNA does not apply to ABD Medicaid.

Community Spouse Resource Allowance (CSRA)

The Community Spouse Resource Allowance (CSRA) is similar to the Monthly Maintenance Needs Allowance described above, but the CSRA regulates assets instead of income. Medicaid has an asset limit, meaning an applicant can’t have more than a certain amount of value in their assets. In most states in 2024, the asset limit for an individual is just $2,000 and for a married couple it’s either $3,000 or $4,000. Normally, all assets of a married couple are considered jointly owned by both spouses for Medicaid purposes. However, the CSRA allows the non-applicant spouse to keep up to $154,140 (as of 2024 in most states and in most circumstances) without impacting the applicant spouse’s asset limit or eligibility.

It’s important to note that the CSRA only applies to Nursing Home Medicaid and Home and Community Based Services (HCBS) Waivers applicants and recipients. The CSRA does not apply to ABD Medicaid. Also, the CSRA can vary by state and the couple’s financial situation.

 

How Marital Status Impacts Medicaid Eligibility Criteria

The eligibility criteria for Medicaid Long Term Care is largely determined by program, state and marital status and, if married, if one or both spouses is applying.

 Did You Know? For Medicaid purposes, widowed and divorced persons are considered single. Re-married persons are considered married.

Single Applicant

Financial eligibility requirements are most straightforward when a single applicant is applying for Medicaid. Numbers may vary slightly from state to state. In most states in 2024, a single individual is eligible for either Nursing Home Medicaid or Home and Community Based Services (HCBS) Waivers when their income is $2,829/month or less, and their assets are valued at $2,000 or less. However, there are exceptions. For example, California has no income limit for Nursing Home Medicaid, but the individual income limit for HCBS Waivers is $1,732/month (from April 2024 to March 2025). And there is no asset limit in California for any of the Medicaid Long Term Care programs. In New York, the 2024 income limit for all 3 types of Medicaid is $1,732/month for an individual, and the asset limit is $31,175.  In Connecticut, the applicant’s income must be less than the cost of the nursing home for Nursing Home Medicaid, and the individual asset limit is $1,600.

The individual income limits for ABD Medicaid are even less consistent, but as of 2024 they range from $943/month to $1,751/month. The individual asset limit for ABD Medicaid is generally $2,000, but there are exceptions, like Florida, where it’s $5,000.

To find the eligibility criteria for your particular situation, you can use our Medicaid Eligibility Requirements Finder by clicking here. You can also use our 50-State Guide to find more detailed descriptions of the Medicaid rules, programs and eligibility criteria in your state.

Married with One Applicant

Eligibility requirements get more complex when one spouse in a married couple applies. Usually, the income of the non-applicant spouse is not counted. Therefore, for most states, the applicant spouse must make less than $2,829/month as of 2024 to qualify for Nursing Home Medicaid or HCBS Waivers. This is the same limit that exists for single applicants. However, remember that income can be transferred from the applicant spouse to the non-applicant spouse to help supplement their income thanks to the Monthly Maintenance Needs Allowance (MMNA). The MMNA ranges from $2,555 – $3,853.50/month depending on the state and the couple’s financial situation.

The asset limit in most states in 2024  for a married applicant with just one spouse applying for or receiving for Nursing Home Medicaid and HCBS Waivers is either $3,000 or $4,000. All assets of a married couple are considered jointly owned for Medicaid purposes and are counted toward that asset limit. However, as we discussed above, the Community Spouse Resource Allowance (CSRA) enables the non-applicant spouse to keep up to $154,140 (in most states in 2024) without it counting toward the applicant’s asset limit.

For ABD Medicaid applicants and recipients who are married, it doesn’t matter if one or both spouses is applying for Medicaid Long Term Care, their financial eligibility criteria will remain the same. The 2024 income limit for a married ABD Medicaid applicant/recipient ranges from $1,415/month to $2,593/month, depending on the state. The 2024 asset limit for a married ABD Medicaid applicant/recipient is $3,000 combined in most states, but there are exceptions, like Florida, where it’s $6,000 combined. Remember, the Monthly Maintenance Needs Allowance and Community Spouse Resource Allowance do not apply to ABD Medicaid.

Married with Two Applicants

For married couples with both spouses applying for or receiving either Nursing Home Medicaid and HCBS Waivers, the 2024 income limit in most states is $5,658/month combined, or it’s $2,829/month for each spouse. In states where the figure is combined, the income total doesn’t need to be allocated evenly between the spouses. The asset limit for a married couple with both spouses applying for or receiving Nursing Home Medicaid or HCBS Waivers is either $3,000 or $4,000 in most states in 2024. Again, as with all these financial eligibility criteria, the numbers can vary by state.

For married couples with both spouses applying for or receiving ABD Medicaid, the 2024 income limit ranges from $1,415/month to $2,593/month combined, depending on the state. And the 2024 asset limit for a married couple with both spouses applying for or receiving ABD Medicaid is $3,000 combined in most states, but there are exceptions, like Florida, where it’s $6,000 combined.

 Toolbox: To find the eligibility criteria for your particular situation, you can use our Medicaid Eligibility Requirements Finder by clicking here.