When one spouse enters a nursing facility and applies for Michigan Medicaid, federal spousal impoverishment rules protect the at-home spouse from being left without resources. In 2026, Michigan's community spouse can keep between $32,532 and $162,660 in countable assets and receive a monthly income allowance of up to $4,066.50, while the spouse in care keeps their own assets down to a $9,950 limit. Michigan is a standard 50%-of-assets state, applying the federal floor and ceiling rather than protecting the full federal maximum for every couple.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf,Centers for Medicare & Medicaid Services. (2026). CMS Informational Bulletin — 2026 SSI and Spousal Impoverishment Standards (Dec 9, 2025). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
Why Michigan Medicaid Spousal Impoverishment Rules Exist
Before Congress enacted spousal impoverishment protections in the Medicare Catastrophic Coverage Act of 1988, a married couple faced a cruel outcome when one spouse needed a nursing facility. Both spouses' assets were pooled and spent down until virtually nothing remained, often leaving the at-home partner in poverty. Congress addressed this by codifying minimum protected amounts into federal law at 42 U.S.C. § 1396r-5.
The Michigan Department of Health and Human Services (MDHHS) applies these rules through its Bridges Eligibility Manual when processing Nursing Home Medicaid, MI Choice Waiver, and PACE applications for married applicants.Centers for Medicare & Medicaid Services. (2026). CMS Informational Bulletin — 2026 SSI and Spousal Impoverishment Standards (Dec 9, 2025). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
How the Calculation Works, Step by Step
Michigan sets the community spouse's protected assets in a fixed sequence, starting the day the spouse in care first enters continuous care.
Establish the snapshot date
When the institutionalized spouse first enters continuous care (a hospital or nursing facility for at least 30 continuous days), MDHHS counts all countable assets held by both spouses combined as of that date. Counted assets include bank accounts, CDs, stocks, bonds, non-qualified annuities, and most other financial holdings. Not counted: the primary home (while the community spouse lives there), one vehicle, household goods, personal effects, and term life insurance with no cash value.
Calculate the CSRA
From the combined snapshot total, the community spouse keeps one-half of the couple's countable assets. If that half falls below $32,532, the community spouse keeps the $32,532 floor; if it exceeds $162,660, the community spouse keeps the $162,660 ceiling; otherwise they keep exactly half.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf
Spend down the institutionalized spouse's share
The spouse in care must reduce their remaining share of countable assets to $9,950, Michigan's long-term-care asset limit, before Medicaid coverage begins.Centers for Medicare & Medicaid Services. (2026). CMS Informational Bulletin — 2026 SSI and Spousal Impoverishment Standards (Dec 9, 2025). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
Set the monthly income allowance (MMNA)
After eligibility, if the community spouse's own monthly income falls below the MMNA, the institutionalized spouse can divert income to fill the gap, up to a maximum of $4,066.50/month once the excess shelter allowance is applied.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf
Worked example #1: A couple's combined countable assets at the snapshot are $90,000. Half is $45,000, which falls within the CSRA range, so the community spouse keeps $45,000. The institutionalized spouse must spend down their $45,000 share to $9,950 before coverage begins.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf,Centers for Medicare & Medicaid Services. (2026). CMS Informational Bulletin — 2026 SSI and Spousal Impoverishment Standards (Dec 9, 2025). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
Worked example #2: The couple has $40,000 in combined assets. Half is $20,000, which falls below the $32,532 floor, so the community spouse keeps the floor of $32,532. The institutionalized spouse's remaining $7,468 is already below the $9,950 limit, so no further spend-down is needed from their share.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf,Centers for Medicare & Medicaid Services. (2026). CMS Informational Bulletin — 2026 SSI and Spousal Impoverishment Standards (Dec 9, 2025). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
The figures above 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.
The Monthly Maintenance Needs Allowance (MMNA)
Once the institutionalized spouse qualifies, a separate rule preserves the community spouse's monthly income. The institutionalized spouse's income normally flows to the nursing facility as the "patient pay amount," after deductions for Medicare and health-insurance premiums, any MMNA transfer, and the $60 personal needs allowance. But when the community spouse's own income falls short of the MMNA, income is diverted to close the gap.Centers for Medicare & Medicaid Services. (2026). CMS Informational Bulletin — 2026 SSI and Spousal Impoverishment Standards (Dec 9, 2025). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
For 2026, the basic MMNA is $2,705.00/month and the maximum is $4,066.50/month.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf The difference is the excess shelter allowance, which raises the MMNA when the community spouse's housing costs exceed a shelter standard that MDHHS publishes and updates. Because that standard changes and the calculation depends on the household's actual shelter expenses, confirm the operative figure with an MDHHS caseworker or an elder-law attorney rather than assuming a fixed amount.Centers for Medicare & Medicaid Services. (2026). CMS Informational Bulletin — 2026 SSI and Spousal Impoverishment Standards (Dec 9, 2025). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
Michigan's Medically-Needy Distinction
Michigan is a medically-needy state. When the institutionalized spouse's income exceeds the $2,982/month special income limit, they do not need a Qualified Income Trust (Miller Trust). Instead, they qualify by incurring medical expenses that "spend down" excess income to Michigan's Protected Income Level.Centers for Medicare & Medicaid Services. (2026). CMS Informational Bulletin — 2026 SSI and Spousal Impoverishment Standards (Dec 9, 2025). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
That protected level is not a single statewide figure; for a household of one it runs roughly $341 to $408 per month depending on the county's shelter area, and for a person in long-term care for the entire month a special institutional standard of $37/month applies. Because the exact standard depends on your county and living situation, confirm the number that applies to you with MDHHS. In practice, for a nursing-home resident the ongoing facility bill by itself usually satisfies the monthly spend-down, which is what makes the medically-needy pathway workable for many Michigan families.Centers for Medicare & Medicaid Services. (2026). CMS Informational Bulletin — 2026 SSI and Spousal Impoverishment Standards (Dec 9, 2025). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
Exempt Assets: The Community Spouse's Protected Core
The following assets are never included in the CSRA snapshot calculation:
- Primary home: fully exempt while the community spouse lives there. The $752,000 equity limit applies to the institutionalized spouse's eligibility, but the cap does not apply at all when a spouse, a child under 21, or a blind or disabled child lives in the home.Centers for Medicare & Medicaid Services. (2026). CMS Informational Bulletin — 2026 SSI and Spousal Impoverishment Standards (Dec 9, 2025). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
- One vehicle: the household's primary car.
- Household goods and personal effects.
- Term life insurance with no cash value.
- Irrevocable prepaid burial contracts within reasonable limits.
The home exemption means the community spouse's housing is secure. The most common financial concern is liquid assets, such as bank and brokerage accounts, and planning the spend-down.
Planning Considerations
Spend down to exempt items. Before the institutionalized spouse applies, the couple may convert countable assets into exempt ones: pay off the home mortgage, make home repairs or modifications, purchase a needed vehicle, or prepay funeral arrangements through an irrevocable burial contract.
Watch the five-year look-back. Michigan applies a 60-month look-back to long-term-care, MI Choice Waiver, PACE, and Home Help applications. An uncompensated transfer (a "divestment") creates a penalty period computed by dividing the transferred value by the 2026 average monthly private long-term-care cost of $12,216.30. Gifts made within the look-back can delay coverage, so plan transfers carefully.Centers for Medicare & Medicaid Services. (2026). CMS Informational Bulletin — 2026 SSI and Spousal Impoverishment Standards (Dec 9, 2025). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
Medicaid-compliant annuity (SPIA). A community spouse may convert countable assets into a Medicaid-compliant Single Premium Immediate Annuity paying income over their actuarial life expectancy. Structured correctly, the converted sum becomes non-countable for the institutionalized spouse's eligibility.
Request a fair hearing. Under 42 U.S.C. § 1396r-5(e), either spouse may request a fair hearing to seek an increased CSRA or MMNA if the community spouse cannot meet their monthly needs at the standard amount. This is a formal administrative process that benefits from legal representation.
| Rule | Amount | Notes |
|---|---|---|
| CSRA minimum | $32,532 | Community spouse keeps at least this |
| CSRA maximum | $162,660 | Community spouse cannot keep more than this |
| CSRA calculation | 50% of combined assets | Subject to floor and ceiling |
| MMNA minimum | $2,705.00/month | Federal basic minimum |
| MMNA maximum | $4,066.50/month | After excess shelter allowance |
| Institutionalized spouse asset limit | $9,950 | More generous than the $2,000 floor in most states |
| Personal Needs Allowance | $60/month | Kept by nursing-home resident |
| Home equity limit | $752,000 | Home exempt while community spouse resides there |
Frequently Asked Questions
Can the community spouse keep the house?
Yes. The primary home is exempt from both the CSRA calculation and the institutionalized spouse's asset test as long as the community spouse lives there, and the $752,000 home-equity cap does not apply while a spouse remains in the home. Michigan's estate recovery program also cannot act while the surviving spouse is alive.Centers for Medicare & Medicaid Services. (2026). CMS Informational Bulletin — 2026 SSI and Spousal Impoverishment Standards (Dec 9, 2025). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
Does Michigan require a Miller Trust?
No. Michigan is a medically-needy state. When an applicant's income exceeds $2,982/month, they qualify by incurring medical expenses to spend down excess income to Michigan's Protected Income Level rather than by creating a Qualified Income Trust. For nursing-home applicants, the monthly facility bill typically satisfies this spend-down on its own.Centers for Medicare & Medicaid Services. (2026). CMS Informational Bulletin — 2026 SSI and Spousal Impoverishment Standards (Dec 9, 2025). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
What happens to the PNA in Michigan?
Michigan's personal needs allowance is $60/month ($90/month for a veteran receiving an Improved Pension). This is the amount the nursing-home resident keeps from their income for personal expenses such as haircuts, clothing, and incidentals. The remainder of their income, after Medicare and health-insurance premiums and any MMNA transfer, goes to the facility as the patient pay amount.Centers for Medicare & Medicaid Services. (2026). CMS Informational Bulletin — 2026 SSI and Spousal Impoverishment Standards (Dec 9, 2025). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
What if the community spouse's income is already above the MMNA?
If the community spouse's income meets or exceeds $2,705.00/month (or the adjusted amount once the excess shelter allowance is applied), no income diversion from the institutionalized spouse occurs. All of the institutionalized spouse's income, after the PNA and insurance deductions, goes to the facility as the patient pay amount.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf
Does Michigan recognize spousal refusal?
Michigan does not have a recognized spousal-refusal procedure. Spousal refusal, in which the community spouse formally declines to support the institutionalized spouse, is used primarily in New York and a small number of other states. Michigan follows the standard 42 U.S.C. § 1396r-5 rules.
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