Medicaid’s Monthly Maintenance Needs Allowance

Summary
Medicaid Long Term Care recipients who are married to a spouse not on Medicaid can transfer some or all of their income to that spouse to prevent them from living in poverty. The income transfer is known as a Monthly Maintenance Needs Allowance (MMNA), and it can also help the applicant/recipient spouse gain or maintain their Medicaid eligibility.

The Monthly Maintenance Needs 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. Nursing Home Medicaid will cover all nursing home expenses, including room and board, for seniors who require as a Nursing Facility Level of Care (NFLOC). HCBS Waivers cover long-term care benefits for seniors who need a NFLOC but want to live in their own home or somewhere else in the community (such as the home of a loved one). ABD Medicaid doesn’t have a medical requirement for general healthcare coverage for financially needy seniors, but for long-term care benefits, ABD Medicaid recipients are required to show a medical need for the benefit.

The Monthly Maintenance Needs Allowance only applies to Nursing Home Medicaid and HCBS Waivers. It does not apply to ABD Medicaid. It can be especially useful for Nursing Home Medicaid recipients, who are otherwise required to give almost all of their income to the state to help cover nursing home expenses.

How the Monthly Maintenance Needs Allowance Works

Essentially, the Monthly Maintenance Needs Allowance (MMNA) allows a married Medicaid applicant/recipient to transfer some or all of their income to their low-income spouse who is not on Medicaid (also known as the community spouse) so the applicant/recipient spouse can avoid living in poverty. If the community spouse’s income is below the Minimum MMNA limit in their state, the applicant/recipient spouse can transfer some or all of their income to the community spouse until they reach the state limit. Plus, that transferred income does not count toward the income limit of the applicant/recipient spouse, so the MMNA can help a senior get under the income limit and qualify for Medicaid.

Some states use both a Minimum MMNA and a Maximum MMNA. In these states, community spouses are automatically entitled to have an income that matches the Minimum MMNA, and they may be entitled to more if their “shelter costs” are high enough. This includes things like rent, mortgage, property tax, homeowner’s insurance and utilities. These states use a preset Monthly Housing Allowance to determine if the community spouse is entitled to more than the Minimum MMNA. That allowance is $766.50/month as of July 1, 2024. If the community spouse’s shelter costs are greater than $766.50, they can add the difference to their MMNA. For example, if a community spouse had shelter costs that totaled $866.50, they would be entitled to an extra $100/month ($866.50 – $766.50 = $100).

Monthly Maintenance Needs Allowances by State

States are allowed to set their Monthly Maintenance Needs Allowance (MMNA) anywhere between the Minimum and Maximum standards set by the federal government. As of July 1, 2024, the federal Minimum MMNA is $2,555 in 48 states and Washington, D.C., with Alaska ($3,192.50) and Hawaii ($2,937.50) being the exceptions. The federal Maximum MMNA is $3,853.50 (effective Jan. 1, 2024 – Dec. 31, 2024).

There are 13 states that currently use $3,853.50 (or round up to $3,854) as their MMNA, which means community spouses are entitled to that amount regardless of their shelter costs. The states that use this one standard figure are Alaska, California, Georgia, Hawaii, Illinois, Iowa, Louisiana, Mississippi, New York, Oklahoma, South Carolina, Texas and Wyoming, as well as Washington, D.C.

There are currently 34 states that use both a Minimum MMNA and a Maximum MMNA and they adhere to the federal standards of $2,555 and $3,853.50 (some round up to $3,854). These states are Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Idaho, Indiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Virginia, Washington and West Virginia.

There are also some states that take a unique approach to the MMNA. Alabama uses one standard figure of $2,555 for its MMNA. North Dakota uses a standard figure of $2,555. And Wisconsin uses a Minimum MMNA of $3,286.66 and a Maximum MMNA of $3,853.50.

Examples of the Monthly Maintenance Needs Allowance

While the general concept is fairly straightforward – transferring income from one spouse to another – the details and nuances involved in the Monthly Maintenance Needs Allowance (MMNA) can be complicated. A good way to tie all the information together is by using a few of examples.

Example 1
Adam and Zelda live in California. Adam has qualified for Nursing Home Medicaid and is moving into a nursing home, while Zelda is not covered by Medicaid and will be living at home. Adam has $5,000/month in income while Zelda has $1,000/month. California uses one standard figure for it Minimum MMNA, which is $3,853.50/month. Given Zelda’s income, Adam is allowed to transfer $2,853.50/month per month to Zelda so she can add that to her $1,000/month and reach the Minimum MMNA of $3,853.50/month.

Example 2
Joe and Cathy live in Ohio, which uses a Minimum MMNA ($2,555/month) and a Maximum MMNA ($3,853.50/month). Cathy is on Medicaid and will be moving into a nursing home, while Joe is not covered by Medicaid and will be staying at home. The Standard Utility Allowance for Ohio is $724/month, which ups the amount Cathy could transfer to Joe to $3,189/month ($2,465 + $724 = $3,189). Joe also has $2,300/month in living expenses, which means he can add another $1,533.50/month to his Monthly Maintenance Needs Allowance limit because Ohio uses the standard $766.50/month to calculate Monthly Housing Allowance ($2,300 – $766.50 = $1,533.50). But adding that total would bring his MMNA limit to $4,722.50/month, which is above the Maximum MMNA, so Joe’s MMNA limit is the Maximum amount of $3,853.50/month. Since Joe has $1,000/month in income of his own, Cathy can transfer to $2,853.50/month to him so he can reach the Maximum MMNA.