Maryland Medicaid Spousal Impoverishment 2026: CSRA & Income

Maryland Medicaid spousal impoverishment rules protect the at-home spouse when a husband or wife enters a nursing home or long-term care waiver on Medicaid. Federal law creates the framework; the Maryland Department of Health (MDH) applies it. In 2026, Maryland's maximum spousal share is $162,660 in countable assets, and an applicant whose income is above Maryland's medically needy level can still qualify through spend-down.

What Maryland Medicaid Spousal Impoverishment Covers

When one spouse qualifies for Maryland Medicaid long-term care, whether in a nursing facility or through a home- and community-based services (HCBS) waiver, federal spousal impoverishment law under 42 USC § 1396r-5 prevents the couple from being left without resources. MDH implements these protections through the Medicaid Medical Care Programs division, with eligibility determinations made by the local department of social services or health department.

Two distinct protections apply: one for assets, one for income. The Community Spouse Resource Allowance (CSRA) governs what the at-home spouse keeps in savings and investments. The Minimum Monthly Maintenance Needs Allowance (MMMNA) governs monthly income.2

Throughout this guide, the at-home spouse is called the community spouse and the spouse entering long-term care is called the institutionalized spouse.

How the CSRA Works in Maryland

The CSRA is the asset-side protection. It determines how much of the couple's combined countable assets the community spouse keeps.2

The calculation

1. Total the couple's assets as of the snapshot date. The count takes in every resource either spouse has an ownership interest in, whichever spouse's name it is in, valued at the start of the institutionalized spouse's first continuous stay in a facility.4

2. Set aside excluded assets. Some property is left out of the count. Ask your local department of social services which of your assets Maryland excludes before you total the rest.

3. Work out the spousal share. Federal law sets the spousal share at one-half of that snapshot total. It is the starting point for the community spouse's allowance, not a guaranteed amount: the minimum and maximum in step 4 can move it up or down.4

4. Apply Maryland's spousal share standards. Maryland's Schedule MA-8 sets the Minimum Spousal Share at $32,532 and the Maximum Spousal Share at $162,660, both effective January 1, 2026, the same figures as the federal resource standards.1 If half the assets falls below the minimum, the community spouse keeps the minimum. If it exceeds the maximum, the standard allowance stops at the maximum. That maximum is not an absolute cap: a CSRA set at a fair hearing, or the amount a court orders transferred to the community spouse, can be higher.2,4

The institutionalized spouse keeps $2,500 in countable assets (Maryland's medically needy individual asset limit, effective February 1, 2026; the state's separate categorically needy standard is $2,000). Any remaining assets above the CSRA plus $2,500 must be spent down before Medicaid activates.1

Worked example #1

The figures below are hypothetical and shown only to illustrate how the calculation works. They are not a real case and not a prediction of your own result.

A Maryland couple has $220,000 in total countable assets on the snapshot date. Half is $110,000, which falls between Maryland's $32,532 minimum and $162,660 maximum spousal share. The community spouse keeps $110,000. The institutionalized spouse must spend down $107,500 (their share minus Maryland's $2,500 medically needy individual limit) before Medicaid covers care.2,1,4

Worked example #2

Again hypothetical, shown only to illustrate the formula.

A couple has $55,000 in total countable assets. Half is $27,500, which is below the $32,532 minimum. The community spouse keeps the minimum: $32,532. The institutionalized spouse has $22,468 remaining, minus the $2,500 medically needy limit, leaving about $19,968 to spend down.2,1,4

How the MMMNA Works in Maryland

The MMMNA is the income-side protection. It sets the monthly income level the community spouse is allowed to reach, and when the community spouse's own income falls short of it, part of the institutionalized spouse's income can make up the difference.2,4

The allowance standards

The federal MMMNA is $2,705.00 per month, effective July 1, 2026 through June 30, 2027, and the federal maximum monthly maintenance needs allowance is $4,066.50 per month, effective January 1, 2026.2 Maryland's own Schedule MA-8 publishes a basic maintenance and shelter allowance of $2,643 (effective 7/1/2025) and a maximum of $4,066 (effective 1/1/2026), so ask MDH or your local department of social services which figure it is applying to your case.1 Neither figure is a hard limit: if either spouse shows at a fair hearing that exceptional circumstances causing significant financial duress mean the community spouse needs more income, the hearing can set a higher allowance.2

The shelter allowance

If the community spouse's housing costs for the home (rent or mortgage payment, property taxes, homeowners insurance and any condo or co-op maintenance charge, plus a utility allowance) exceed the excess-shelter standard, the excess can raise the allowance, up to the maximum.4 Maryland's Schedule MA-8 sets that excess shelter standard at $793 and the maximum maintenance and shelter allowance at $4,066 (effective 1/1/2026).1 Because these standards reset periodically, confirm the current amounts with MDH or your local department of social services before relying on a specific number.

How the income transfer works

While the institutionalized spouse is in the facility, none of the community spouse's own income is counted as available to the institutionalized spouse.2 Once the institutionalized spouse is found eligible, a community spouse monthly income allowance (CSMIA) can be deducted from their monthly income, after their personal needs allowance. The CSMIA is the amount by which the MMMNA exceeds the community spouse's own monthly income, and it is deducted only to the extent the institutionalized spouse's income is actually made available to the community spouse. If a court has ordered the institutionalized spouse to pay monthly support to the community spouse, the allowance is at least the ordered amount.4 The institutionalized spouse's income left after the allowed deductions goes toward the cost of care.1

Maryland's medically needy spend-down and the waiver income limit

Maryland is a medically needy state. Its medically needy income level is $350 a month for one person and $392 for two (effective January 1, 2026). An applicant whose income is above that can still become eligible through spend-down, which Maryland's regulations describe as deducting incurred medical expenses from excess income.1

The Community Options Waiver, which pays for long-term care at home and in the community, uses a different income test: monthly income may not exceed 300% of SSI benefits, which is $2,982 a month in 2026. MDH says an applicant denied because income is too high may be eligible for the Increased Community Services Program.1

The Home and Other Exempt Assets

Some assets are left out of the Medicaid eligibility calculation, and the home is the one most families ask about first.

The home. Maryland's Schedule MA-10 sets the home-equity limit for long-term care coverage at $752,000.1 Federal law switches that limit off entirely while the applicant's spouse, a child under 21, or a child who is blind or permanently and totally disabled lawfully lives in the home, so for a married couple with the community spouse at home, equity of any amount does not by itself disqualify the applicant. Where the limit does apply, equity over it can be brought down with a reverse mortgage or home equity loan.3

Other assets. Ask your local department of social services which of your other assets Maryland excludes before you total your countable assets.

Maryland's medically needy (non-MAGI) individual asset limit (the standard that governs long-term-care applicants) is $2,500, effective February 1, 2026; the state's separate categorically needy standard is $2,000. This means the institutionalized spouse keeps $2,500 after the CSRA is applied.1

Before filing, ask your local department of social services or an elder law attorney how Maryland will count IRAs, 401(k)s and similar retirement accounts.

The Snapshot Date

The snapshot date is the beginning of the institutionalized spouse's first continuous period of institutionalization. It is fixed by when that first continuous stay began, not by when you apply.4

The snapshot matters because the spousal share, half of the couple's combined assets, is worked out from what the couple owned on that date. Eligibility itself is judged at application: everything either spouse holds then counts as available to the institutionalized spouse, but only to the extent it exceeds the community spouse's allowance.4

A hypothetical, for illustration only: a couple holds $280,000 when one spouse enters a nursing home in February, then spends $70,000 on private-pay care before applying in July. The spousal share is still half of the February total, $140,000, which sits between Maryland's $32,532 minimum and $162,660 maximum. At the July application the couple holds $210,000, so about $70,000 is above the community spouse's allowance, and the institutionalized spouse must bring that down to Maryland's $2,500 medically needy limit before qualifying.4,1

You don't have to wait for the application to pin the numbers down. At the start of that first continuous stay, either spouse can ask the state to assess and document the couple's total assets. The state must do it promptly once it has the documentation, give each spouse a copy with notice of the right to a fair hearing, and may charge a fee capped at its reasonable costs if the request isn't part of a Medicaid application. Gathering bank and investment statements as of the snapshot date early makes that assessment, and the later application, much easier.4

Maryland's Personal Needs Allowance

Maryland's nursing home Personal Needs Allowance is $106 per month for an individual and $212 for a couple, effective July 1, 2025, well above the federal floor of $30 a month. This is the amount the institutionalized spouse keeps each month from their own income for personal expenses; the rest of that income, after the allowed deductions, goes toward the cost of care. It does not affect the community spouse's protections, but it is worth knowing when reviewing the patient liability calculation.1

Applying for Maryland Medicaid Spousal Impoverishment Protections

Maryland Medicaid long-term care applications are filed through the local department of social services or local health department, or online through Maryland Health Connection for some pathways. A nursing facility's social worker can assist with the initial paperwork but cannot substitute for family-gathered financial documentation. Gathering documentation before filing saves time.

Where to Get Help in Maryland

Learn More

Find personalized help navigating Maryland Medicaid spousal impoverishment 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.