When a husband or wife needs nursing-home care, DC Medicaid lets the at-home spouse keep up to $162,660 in savings and $4,066.50 a month in income in 2026. You do not have to spend down to nothing first. These protections come from the federal spousal impoverishment law at 42 U.S.C. 1396r-5, which the District follows: the community spouse keeps between $32,532 and $162,660 in countable assets and up to $4,066.50 a month in income. DC's long-term care covers both nursing-facility care and the Elderly and Persons with Physical Disabilities (EPD) Waiver at home; confirm with DHCF how the community-spouse allowances apply to waiver care in your situation.

In This Guide

How DC Medicaid Spousal Impoverishment Works

When one spouse enters a nursing facility or qualifies for a home- and community-based services waiver, the other spouse does not have to be left destitute to get coverage. That is the point of the spousal impoverishment rules: the at-home spouse keeps a protected share of the couple's assets and income while Medicaid pays for the other spouse's care.

In the District of Columbia, Medicaid is administered by the Department of Health Care Finance (DHCF), the District's state Medicaid agency. DHCF's long-term care programs cover both nursing-facility care and the Elderly and Persons with Physical Disabilities (EPD) Waiver, the District's 1915(c) home- and community-based waiver run by the Department of Aging and Community Living (DACL). The federal spousal impoverishment framework governs the community-spouse asset and income allowances for Medicaid long-term care; how those allowances are applied to an EPD Waiver case is determined by DHCF, so confirm the treatment for waiver care directly with the agency before you rely on it.

Two terms run through every rule below. The spouse entering long-term care is the institutionalized spouse (the applicant). The spouse who stays in the community is the community spouse. The District applies the federal spousal impoverishment framework at 42 U.S.C. 1396r-5, which has two parts: a resource (asset) allowance and an income allowance for the community spouse.

Protection 2026 amount How it works
CSRA minimum $32,532 The community spouse keeps at least this in assets, even when half the couple's assets is less
CSRA maximum $162,660 The community spouse keeps no more than this, even when half the couple's assets is more
MMMNA floor $2,705.00/month Income level the community spouse is brought up to through a diversion from the applicant
MMMNA ceiling $4,066.50/month Highest income the community spouse can reach by claiming excess shelter costs
Applicant asset limit $4,000 The institutionalized spouse must spend down to this before coverage begins
Personal Needs Allowance $109/month Kept by the institutionalized spouse before the patient share is calculated

How the CSRA Protects Your Spouse's Assets

The Community Spouse Resource Allowance (CSRA) is the portion of the couple's countable assets the community spouse keeps when the institutionalized spouse applies for DC Medicaid long-term care. DC does not run a separate state formula here. It applies the federal one: the community spouse keeps one-half of the couple's total countable assets as of the snapshot date, bounded by a 2026 minimum of $32,532 and a maximum of $162,660.

The Snapshot Date

Before DC calculates the CSRA, the program takes a snapshot of the couple's total countable assets as of the first day of a continuous period of institutional or waiver care. Both spouses' assets are counted at that moment, regardless of whose name is on each account.

The snapshot figure is what fixes the CSRA, not the couple's balance on the day the Medicaid application is filed. Because the CSRA is locked to that frozen number, the assessment is worth requesting as soon as a continuous stay begins rather than waiting until you file.

The Half-of-Assets Formula

The community spouse keeps half of the couple's countable assets at the snapshot, subject to the federal floor and ceiling:

  • Minimum CSRA: $32,532. If half the couple's assets is less than this, the community spouse still keeps $32,532.
  • Maximum CSRA: $162,660. If half the couple's assets exceeds this, the community spouse keeps $162,660 and no more.

The example below is hypothetical, shown only to illustrate how the calculation works. It is not a real case and not a prediction of your own result.

A couple in Ward 4 has $180,000 in countable assets at the snapshot date. Half is $90,000, which falls between the $32,532 floor and the $162,660 ceiling, so the community spouse keeps $90,000. The remaining $90,000 is the institutionalized spouse's share. Because DC lets a long-term care applicant keep only $4,000 in countable assets, roughly $86,000 of that share must be spent down before Medicaid coverage begins.

What Counts as a Countable Asset?

Both spouses' assets are pooled at the snapshot, no matter whose name holds them. Countable assets generally include:

  • Checking and savings accounts
  • CDs and money market funds
  • Stocks, bonds, and mutual funds
  • Both spouses' IRAs and retirement accounts
  • Non-home real estate

Assets that DHCF excludes from the eligibility calculation include the home, one vehicle, and ordinary household and personal goods. Prepaid irrevocable burial arrangements are also commonly excluded; confirm the current treatment with DHCF for your own case.

How the MMMNA Protects Your Spouse's Income

The Minimum Monthly Maintenance Needs Allowance (MMMNA) is the income floor for the community spouse. For 2026, DC applies the federal range:

  • Floor (minimum MMMNA): $2,705.00 a month, effective July 1, 2026 through June 30, 2027.
  • Ceiling (maximum MMMNA): $4,066.50 a month, effective January 1, 2026.

Your Spouse Keeps Their Own Income

Under 42 U.S.C. 1396r-5, only the institutionalized spouse's income is measured against the cost of care. Income paid in the community spouse's own name stays with the community spouse and does not count toward the applicant's eligibility. The MMMNA matters only when the community spouse's own income falls below the floor.

Income Diversion

When the community spouse's own monthly income is below the MMMNA floor, DC allows an income diversion from the institutionalized spouse's income to bring the community spouse up to the floor.

The institutionalized spouse's income is first reduced by the $109 Personal Needs Allowance, any Medicare or health-insurance premiums, and other allowed deductions. From what remains, enough is diverted to the community spouse to reach the MMMNA floor. Whatever is left is the patient share paid to the facility, and DC Medicaid covers the balance of the bill.

The example below is hypothetical, shown only to illustrate how the calculation works. It is not a real case and not a prediction of your own result.

The community spouse receives $1,500 a month from Social Security. The MMMNA floor is $2,705.00, so the shortfall is $1,205.00 a month. The institutionalized spouse receives $2,400 a month from a pension and Social Security. After subtracting the $109 Personal Needs Allowance and any Medicare premium, most of the remainder is available, and $1,205.00 of it is diverted to the community spouse to meet the floor. The rest is the patient share, and DC Medicaid pays the remaining facility cost.

Reaching the MMMNA Ceiling

A community spouse can move above the floor toward the $4,066.50 ceiling by claiming excess shelter costs. Rent or mortgage, property taxes, homeowners or renters insurance, and utilities that run above a federal shelter standard (the community-spouse monthly housing allowance, $811.50 a month effective July 1, 2026) raise the allowable income toward the ceiling. Ask DHCF how the current standard applies to your household.

What the Applicant Spouse Must Meet

The community spouse's allowances are calculated independently of the institutionalized spouse's own eligibility test. The applicant still has to meet DC's long-term care financial rules.

Assets. The institutionalized spouse must reduce countable assets to $4,000 (the DC individual long-term care asset limit; the couple limit is $6,000). The share protected as the CSRA is transferred to the community spouse and does not count against this limit.

Income. DC covers institutional and waiver long-term care through a Special Income Standard equal to 300% of the Supplemental Security Income (SSI) federal benefit rate, $2,982.00 a month in 2026. An applicant whose income runs above that standard is not automatically shut out: DC also offers a Medically Needy spend-down, with a medically needy income level of $856.90 a month for one person over a six-month budget period, so an over-income applicant can qualify by incurring medical and care costs against that level. The EPD Waiver uses the same 300%-of-SSI income standard, or the ability to meet a spend-down.

Personal Needs Allowance. Once eligible, a DC nursing-facility resident keeps a Personal Needs Allowance of $109 a month, effective January 1, 2026, before the patient share is calculated.

The Home and Home Equity

The primary residence is excluded from the Medicaid eligibility calculation while the community spouse lives in it. Federal law also sets a home-equity limit for long-term care eligibility that for 2026 ranges from a $752,000 minimum to a $1,130,000 maximum, indexed to inflation. That indexing is scheduled to end: a 2025 federal law, the One Big Beautiful Bill Act (Public Law 119-21), will cap the limit at a flat $1,000,000 beginning January 1, 2028, for every home except one on a lot zoned for agricultural use, which stays under the indexed rules. While the community spouse lives in the home, that equity cap rarely blocks eligibility.

Being exempt for eligibility is not the same as being safe after death. What happens to the home once both spouses are gone is governed by estate recovery, covered next.

Estate Recovery and the Surviving Spouse

DHCF must recover Medicaid long-term care costs from the estate of a beneficiary who received coverage at age 55 or older, and an estate includes all real and personal property, including a home, that does not pass to another person at the time of death. For the community spouse, the protection that matters most is timing.

DC does not pursue recovery while a surviving spouse, a child under 21, or a blind or disabled child lives in the home. Recovery may proceed only after that survivor no longer lives in the home and it is sold. The District must also waive or reduce its claim when recovery would cause an undue hardship. Families who want to keep the home should ask DHCF about the exemptions and the undue-hardship process, and consult a DC elder law attorney before planning around them.

DC Medicaid Spousal Impoverishment and the Application Process

DHCF is the District's state Medicaid agency, and financial eligibility for DC Medicaid is determined through the Department of Human Services' Economic Security Administration (ESA); the District does not require an in-person interview. Protecting the community spouse's share works best when the snapshot is locked early, so the sequence below starts before you file.

1
Step 1

Request an asset assessment as of the snapshot date

As soon as the institutionalized spouse begins a continuous period of institutional or waiver care, ask for the couple's total countable assets to be captured as of that date. The snapshot freezes the figure the CSRA is calculated from.

2
Step 2

Gather every countable asset

Assemble statements for both spouses' bank, brokerage, and retirement accounts, cash-value life insurance, deeds to any non-home real estate, and vehicle titles, joint accounts included, regardless of whose name is on them.

3
Step 3

Apply for DC Medicaid long-term care

Apply online at districtdirect.dc.gov, or call the ESA Public Benefits Call Center at (202) 727-5355. For EPD Waiver care at home, DACL's Medicaid Services Enrollment Unit coordinates and submits the waiver application.

4
Step 4

Spend the applicant's share down to the limit

With the CSRA locked, reduce the institutionalized spouse's share to the $4,000 applicant asset limit using exempt-asset conversions or private-pay care before coverage begins. Both spouses can appeal any determination through a DC fair hearing before the DC Office of Administrative Hearings.

For the full walkthrough of the application itself, see DC Medicaid long-term care and how DC Medicaid pays for care at home.

Planning Strategies to Consider

DC's federal-maximum CSRA ceiling and its dual income pathways give couples a solid baseline. Cases where extra planning may help:

  • Converting countable assets to exempt ones, such as home repairs, a replacement vehicle, or prepaid irrevocable burial arrangements, to reduce the applicant's spend-down.
  • Community-spouse annuities that turn excess countable assets into an income stream, using an annuity structured to meet Medicaid's requirements; the rules are technical, so work with a District-licensed elder law attorney before setting one up.
  • Requesting a fair hearing if the CSRA does not produce enough income to reach the MMMNA, which can raise the resource allowance in some cases.

Couples with assets well above the CSRA ceiling should consult a District-licensed elder law attorney before applying.

Frequently Asked Questions

How much can my spouse keep when I apply for DC Medicaid nursing home coverage?

Your spouse keeps one-half of the couple's countable assets at the snapshot date, at least $32,532 and no more than $162,660 for 2026. Your spouse also keeps their own income and may receive a diversion from your income to reach the MMMNA floor of $2,705.00 a month, up to a ceiling of $4,066.50 a month.

Do DC's spousal impoverishment rules apply to the EPD Waiver, or only to nursing homes?

DC's long-term care covers both nursing-facility care and the EPD Waiver. The federal spousal impoverishment framework governs the community-spouse asset and income allowances for Medicaid long-term care; how those allowances are applied to an EPD Waiver case is determined by DHCF, so confirm the treatment for waiver care directly with the agency.

What income limit does the applicant spouse have to meet in DC?

DC covers long-term care through a Special Income Standard of 300% of the SSI federal benefit rate, $2,982.00 a month in 2026. An applicant above that standard can still qualify through DC's Medically Needy spend-down, which uses a medically needy income level of $856.90 a month for one person.

What is the Personal Needs Allowance in DC?

A DC nursing-facility resident keeps a Personal Needs Allowance of $109 a month, effective January 1, 2026. It is deducted before the patient share and the income diversion to the community spouse are calculated.

Is the home at risk while my spouse still lives there?

Not for eligibility. The home is excluded while the community spouse lives there, and the 2026 federal home-equity limit starts at $752,000. After both spouses have died, DHCF estate recovery can seek repayment, but not while a surviving spouse or a minor or disabled child lives in the home.

Where to Get Help With DC Medicaid Spousal Impoverishment

DC Department of Health Care Finance (DHCF) The District's state Medicaid agency; oversees long-term care eligibility, the CSRA snapshot, and spousal-impoverishment determinations. dhcf.dc.gov
ESA Public Benefits Call Center Takes DC Medicaid applications and answers questions about long-term care eligibility. Apply online or by phone; no in-person interview is required. (202) 727-5355 districtdirect.dc.gov
DC Department of Aging and Community Living (DACL) Runs the EPD Waiver and its Medicaid Services Enrollment Unit for spouses who need long-term care at home rather than in a facility. dacl.dc.gov/service/epd-waiver
DC Office of Administrative Hearings (OAH) Hears Medicaid fair-hearing appeals if a CSRA, MMMNA, or eligibility determination is disputed. oah.dc.gov/page/medicaid
Your next step Ask for an asset-assessment snapshot as soon as the institutionalized spouse begins a continuous long-term care stay, then apply for DC Medicaid long-term care online at districtdirect.dc.gov or through DACL for the EPD Waiver. Locking the snapshot date early is what protects the community spouse's share before you file.

Learn More

MedicaidDC Medicaid Long-Term Care: Nursing Home and the EPD WaiverDC Medicaid pays for long-term care in a nursing home or at home through the EPD Waiver. See the 2026 income standard and how to qualify in the District. MedicaidHow DC Medicaid Pays for Care at Home: The EPD WaiverHow District of Columbia Medicaid HCBS waivers work in 2026: the EPD Waiver, who qualifies, what it covers, income and asset limits, and how to apply. MedicaidDC Medicaid Estate RecoveryDC Medicaid estate recovery in 2026: what DHCF recovers, the age-55 trigger, the home lien, the spouse and disabled-child exemptions, and hardship waivers. MedicaidHow to Apply for DC MedicaidHow to apply for DC Medicaid: the four channels (District Direct, ESA, phone, mail), the documents to gather, timelines, and how to appeal a denial. MedicaidDC Medicaid GuideDistrict of Columbia Medicaid is run by DHCF: 138% FPL adult coverage, a $4,000 asset limit for long-term care, the EPD Waiver, and QMB up to 300% FPL.

Find personalized help protecting the at-home spouse under DC Medicaid at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.