Medicaid’s Community Spouse Resource Allowance: Protecting a Spouse’s Assets

Summary
Medicaid Long Term Care applicants must have limited financial resources and are required to meet a low asset limit. For married applicants, the assets of both spouses are usually counted toward that limit. However, when just one spouse in a married couple applies for certain types of Medicaid Long Term Care, the non-applicant spouse is allowed to keep assets well beyond the limit to prevent them from living in poverty. This is known as the Community Spouse Resource Allowance (CSRA).

 

The Community Spouse Resource Allowance and the 3 Types of Medicaid Long Term Care

There are three types of Medicaid Long Term Care relevant to seniors – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers and Aged, Blind and Disabled (ABD) Medicaid.

The Community Spouse Resource Allowance only applies to Nursing Home Medicaid and HCBS Waivers. It does not apply to ABD Medicaid.

Nursing Home Medicaid covers all costs associated with a nursing home, including room and board, for seniors who require as a Nursing Facility Level of Care (NFLOC). HCBS Waivers will cover long-term care goods and services for seniors who require a NFLOC but wish to live in their home or somewhere else in the community (such as the home of a loved one). ABD Medicaid doesn’t have a level of care requirement for general healthcare coverage, but it will cover long-term care benefits to recipients who show a medical need for those benefits.

 

How the Community Spouse Resource Allowance Works

In short, the Community Spouse Resource Allowance allows a couple to keep up to $154,140 of their assets and still have one spouse qualify for Medicaid Long Term Care, while the other spouse, who is not on Medicaid, can avoid living in poverty.

The bigger picture starts with Medicaid Long Term Care’s financial requirements – the asset limit and the income limit. In most states in 2024, the asset limits for Nursing Home Medicaid and HCBS Waivers are $2,000 for an individual and a combined $3,000 or $4,000 for a married couple. However, when just one spouse in a married couple is applying for either Nursing Home Medicaid or HCBS Waivers, the Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to keep up to $154,140 (depending on the state) in assets to prevent them from living in poverty. The non-applicant spouse can also be called the community spouse or the well spouse. And remember, the CSRA does not apply to Aged, Blind and Disabled (ABD) Medicaid.

Medicaid state officials should implement the CSRA when it’s relevant to an application. However, this doesn’t always happen, or happen correctly, so applicants or their representatives should also do the calculations and make it clear they will be using the CSRA on their application.

It should also be noted that asset limits can vary from state to state. For example, the 2024 asset limits in New York for all three types of Medicaid Long Term Care are $31,175 for an individual and $42,312 for a married couple. In Illinois, the asset limit for all three types of Medicaid Long Term Care for both individuals and couples is $17,500. And California has no asset limit.

To figure out the financial requirements for your specific situation, you can use our Medicaid Eligibility Requirements Finder by clicking here.

 Did You Know? A similar rule exists regarding the income of the community spouse. This rule is called the Minimum Monthly Maintenance Needs Allowance (MMMNA).

 

What Assets are Counted and Exempt for the CSRA?

Most assets are counted toward the asset limit, which means they’re also counted toward the Community Spouse Resource Allowance. In general, assets that can be easily converted into cash (also known as liquidated) will be counted. The government assumes that if a couple has liquid assets, those assets could be used to pay for long-term care. Examples of countable assets include:

  • Cash
  • Bank account funds
  • Certificates of deposit
  • Stocks
  • Bonds
  • Vehicles other than a primary vehicle
  • Vacation properties including timeshares
  • RVs / motorhomes
  • Life insurance policies with a cash value over $1,500 (in most states)

However, some assets are exempt, which means they are not counted. Examples of non-countable assets include:

  • The couple’s primary home (in most cases)
  • Household furniture and appliances
  • Clothing
  • Primary vehicle
  • Irrevocable Funeral Trusts with a cash value up to $15,000 (in most states)
  • Life insurance policies with a cash value under $1,500 (in most states)

There are many regulations and nuances impacting home ownership and Medicaid eligibility, like the state, the value of the home, who lives there and the intent to return home of the Medicaid applicant/recipient. To learn more about how homes impact eligibility, click here.

 IRAs and 401(k)s may be countable or exempt assets depending on their payout status, your state and your marital status. To learn about the impact of retirement accounts on Medicaid eligibility, click here.

 

Minimum and Maximum Community Spouse Resource Allowance Amounts (2024)

Dollar limits on Community Spouse Resource Allowances (CSRAs) can vary by state. The federal government sets absolute limits, and from there states create their own limits within the federal range. For 2024, the Minimum CSRA is $30,828 and the Maximum CSRA is $154,140. States must set their 2024 limits between these two figures.

Some states use one standard CSRA amount instead of a Maximum and Minimum. Many states use the Maximum total of $154,140 as their standard figure, but some states use a lesser total. Illinois, for example, uses a standard figure of $129,084, and South Carolina’s standard CSRA is $66,480.

 

How to Calculate the Community Spouse Resource Allowance

To determine a couple’s assets, Medicaid will use what the couple has on a specific date. This date is called the “snapshot” day. Generally, the snapshot day is either the first day of the applicant spouse’s institutionalization or the date they qualified for Medicaid Long Term Care. On the snapshot day, all of the countable assets owned by either spouse are added up.

States vary on the next step in the calculation. In many states, the total assets of the couple are then divided in half and the non-applicant spouse is only entitled to keep assets up to that half, as long as it’s between the state’s Minimum and Maximum Community Spouse Resource Allowance figures discussed in the previous section. These states are sometimes referred to as 50% states.

Some states allow the non-applicant spouse to keep all of the couple’s assets up to the state’s CSRA limit. These states are called 100% states. To see which rules apply to your state, see our 50-State table below.

Example: A couple lives in a 50% state. The couple’s countable assets totaled $100,000. In their state, the non-applicant spouse is allowed a maximum CSRA of the federal limit, $154,140. Rather than being able to keep all $100,000 in assets, the state will only allow the non-applicant spouse to keep up to half of the total assets. The non-applicant spouse would have a CSRA of $50,000.

Example: A couple lives in a 100% state. Their countable assets total $100,000, and their state has a maximum CSRA of $154,140. In this example, rather than only being allowed to keep half, the non-applicant spouse would be entitled to keep all of the couple’s countable assets up to the state’s limit. The non-applicant spouse in this example would keep the full $100,000.

 

Table: 50% and 100% States for Medicaid Community Spouse Resource Allowance

Medicaid 50% and 100% States for Community Spouse Resource Allowance – Updated Jan. 2024
50% States 100% States
Alabama
Arizona
Arkansas
Connecticut
Delaware
Idaho
Indiana
Iowa
Kansas
Kentucky
Maryland
Massachusetts
Michigan
Missouri
Montana
Nebraska
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Dakota
Tennessee
Texas
Utah
Virginia
Washington
Washington DC
West Virginia
Wisconsin
Alaska
Colorado
Florida
Georgia
Hawaii
Illinois
Louisiana
Maine
Minnesota
Mississippi
Nevada
South Carolina
Vermont
Wyoming