Nebraska Medicaid Spousal Impoverishment 2026: CSRA & MMMNA

Nebraska Medicaid spousal impoverishment rules protect the at-home spouse when one partner needs nursing facility care, using the same 2026 asset figures as the federal standards.1

How Nebraska Medicaid Spousal Impoverishment Works

When one spouse enters a nursing facility, Nebraska applies the federal spousal impoverishment protections in 42 USC § 1396r-5. These rules split into two parts: a resource (asset) protection for the at-home spouse and an income protection.5

Nebraska runs a Medically Needy program: an applicant whose income is over the limit obligates the income above the Medically Needy Income Level to medical bills, a share of cost also called a spenddown.1 That shapes how the institutionalized spouse qualifies. The community spouse's income allowance is taken out of the institutionalized spouse's income first, before the rest goes toward the cost of care.5

The spouse entering long-term care is called the institutionalized spouse. The spouse who remains at home is the community spouse.

How the CSRA Works

The Community Spouse Resource Allowance (CSRA) is the portion of the couple's countable assets that the community spouse gets to keep when the institutionalized spouse applies for Nebraska Medicaid long-term care coverage.2

The Snapshot Date

Before Nebraska calculates the CSRA, it takes a snapshot: the total value of the resources either spouse owns, figured as of the beginning of the institutionalized spouse's first continuous period of institutionalization. Half of that total is the spousal share.5

The snapshot matters because it fixes the spousal share. The allowance itself is computed when you apply, so spending between admission and application changes what the couple holds, but not the spousal share it is measured against.5

The Half-of-Assets Formula

Under the standard formula, the community spouse keeps her spousal share, half of the couple's total countable assets at the snapshot date, but never less than the minimum and, unless a fair hearing or court order sets more, no more than the maximum.5

For 2026:

• Minimum: $32,532 (if half the couple's assets is less than this, the community spouse still keeps $32,532)2
• Standard maximum: $162,660 (if half the couple's assets exceeds this, the standard formula stops at $162,660)2

Nebraska's reserved amount uses these same figures, effective January 1, 2026.1

A worked example illustrating the formula:

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 couple in Omaha has the following countable assets at the snapshot date: $90,000 in joint savings and $50,000 in the institutionalized spouse's IRA. Total: $140,000.2

Half of $140,000 is $70,000. That falls between the $32,532 minimum and the $162,660 standard maximum, so the community spouse keeps $70,000.2

The institutionalized spouse's share is $70,000. Of that, Nebraska allows a $4,000 applicant asset limit. The remaining $66,000 must be spent down before Medicaid eligibility is established.1

What Counts as a Countable Asset?

Both spouses' assets are pooled for the snapshot regardless of whose name is on the account: it counts every resource in which either spouse has an ownership interest.5 Countable assets typically include:

• Checking and savings accounts
• CDs and money market funds
• Stocks, bonds, and mutual funds
• Both spouses' IRAs and 401(k)s
• Cash surrender value of life insurance, once the total face value of the policies on one person tops $1,5006
• Non-home real estate and investment property

Federal SSI rules, the baseline for aged and disabled Medicaid, leave out the home you live in, household goods and personal effects, one vehicle used for transportation, and burial spaces.6 More detail in the section below.

How the MMMNA Works

The Minimum Monthly Maintenance Needs Allowance (MMMNA) is the income protection for the at-home spouse. The floor is what matters to a Nebraska household: she keeps all of her own income, and the MMMNA is the monthly total that an allowance from the applicant's income tops her up to when her own income falls short. The maximum limits that allowance, not what she may keep.1

For 2026, the figures are:1

• Federal minimum MMMNA: $2,705.00/month (effective 7/1/2026 through 6/30/2027)2
• Maximum MMMNA: $4,066.50/month (effective 1/1/2026)2

Nebraska's own standards table, revised October 6, 2026, prints the maximum as $4,066 a month and still lists the minimum row as $2,644 effective July 1, 2025, rather than a July 2026 figure. That $2,644 row is the superseded 2025 figure: federal law requires a state's minimum to equal or exceed 150 percent of the poverty line for two, adjusted each July 1, so $2,705.00 is the minimum from July 1, 2026. If DHHS uses $2,644 for your case, ask about it. If either spouse shows at a fair hearing that she needs more because of exceptional circumstances causing significant financial duress, a higher amount can be substituted.1,2

The Name-on-the-Check Rule

Under federal law, the community spouse keeps all of her own income regardless of amount. If she receives a pension of $3,500/month, she keeps every dollar. This is the "name on the check" rule (42 USC § 1396r-5(b)(2)): income paid solely in the community spouse's name is considered available only to her.2

Only the institutionalized spouse's income flows toward the nursing facility cost.

Income Diversion

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

How this works: the institutionalized spouse keeps the Personal Needs Allowance ($75/month in Nebraska).1 After that, enough of his income is allotted to the community spouse to reach the MMMNA, but only to the extent he actually makes it available to her.5 After any other allowed deductions, the net remaining amount is the institutionalized spouse's patient liability, paid to the nursing facility. Nebraska Medicaid pays the facility balance.

Worked example #1 illustrating income diversion:

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.

The community spouse receives $1,200/month from Social Security. Using the federal MMMNA floor of $2,705.00/month, her shortfall is $1,505.00/month. The institutionalized spouse receives $2,200/month from Social Security and a small pension. After the $75 personal needs allowance, he has $2,125 left. Of that, $1,505.00 goes to the community spouse. What remains, less any other allowed deductions such as his Medicare Part B premium (Medicare sets this each year; confirm the current amount before applying this to a real household), goes to the nursing facility as patient liability. Nebraska Medicaid covers the rest of the facility bill.2

The community spouse moves from $1,200/month to $2,705.00/month.2

Raising the MMMNA Toward the Maximum

The community spouse's allowance can rise above $2,705.00, up to the $4,066.50 maximum, if she has excess shelter costs. Rent or mortgage (principal and interest), property taxes, homeowners insurance, any condo or co-op maintenance charge, and a utility allowance that together exceed the federal excess-shelter standard raise her MMMNA by the difference.5 That standard is $811.50 a month from July 1, 2026; it changes each year, so confirm the figure DHHS is using before relying on it.2

The Home

The home is exempt as a resource while the community spouse lawfully lives in it, without regard to its equity.3

For 2026, the federal home-equity minimum is $752,000, and a state may substitute a higher amount up to $1,130,000. That limit does not apply at all while a spouse lawfully lives in the home, so equity of any amount does not by itself disqualify the applicant.4

Medicaid's federal 60-month look-back applies to asset transfers, counted back from the application. Transferring the home to a child within that window can create a penalty period, unless an exception applies, such as a child under 21, a blind or disabled child, or a caregiving child who lived there for the two years before admission.4 If protecting the home from eventual estate recovery is a concern, note that Nebraska is an expanded-estate state. After both spouses die, recovery can reach the recipient's interest in a home even when it passes outside probate. Nebraska law does bar DHHS from foreclosing on a lien on the home if a sibling with an equity interest lived there for at least the year before admission and has lived there continuously since, or while the home is the residence of an adult child who lived there for the two years before institutionalization and provided care that delayed it (Neb. Rev. Stat. § 68-919(2)); a physician's written attestation of that care is sufficient documentation. But DHHS's own Estate Recovery FAQ says it does not put liens on property and collects as a creditor, so don't treat that bar as an automatic shield for the home. For a live-in heir who gave unreimbursed care that delayed nursing home entry, the route Nebraska's State Plan names is a discretionary undue-hardship waiver, applied for in writing.7 Consult a Nebraska elder law attorney about caregiver child exceptions and other planning options.

Assets That Are Exempt

Federal SSI resource rules are the baseline for aged, blind, and disabled Medicaid, though a state may use less restrictive methods, so confirm how DHHS treats any item below. Under those rules, these are left out of the count:6

• Primary residence (exempt while the community spouse lives there; the $752,000 federal home-equity minimum for 2026 does not apply then)3,4
• One vehicle, regardless of value, used for transportation by you or a household member6
• Household goods and personal effects (furniture, clothing, appliances)
• Burial funds up to $1,500 each, kept separate and set aside for burial; Nebraska's maximum for a burial trust is $6,924 (effective September 1, 2026)6,1
• Burial spaces for the applicant and immediate family
• Life insurance whose total face value on one person is $1,500 or less6

Nebraska Medicaid Spousal Impoverishment and the Application Process

Who Administers This

Nebraska Medicaid for long-term care is overseen by the Division of Medicaid and Long-Term Care at the Nebraska Department of Health and Human Services (DHHS). The community spouse's CSRA and MMMNA are calculated by DHHS as part of the nursing home Medicaid application.1

How to Request a Resource Assessment

Either spouse can ask the state for a resource assessment at the start of the nursing facility stay. With the couple's documentation in hand, the state must promptly total and record their resources, give each spouse a copy with notice of the right to a fair hearing, and keep a copy itself. A couple doesn't need to file a full Medicaid application to ask for one, though when the request isn't part of an application the state may charge a fee capped at the reasonable cost of the assessment.5

Asking at admission, while statements are fresh, makes the snapshot easier to document. To apply for Medicaid itself, use iServe Nebraska, apply over the phone, or mail a paper application to the nearest DHHS office.1

The Application Process

Nebraska Medicaid long-term care applications follow these general steps. For a full walkthrough, see the Nebraska Medicaid how-to-apply guide.

Nebraska Spousal Impoverishment and Spend-Down

Nebraska's route for an institutionalized spouse whose income is too high is its Medically Needy program. Income above the Medically Needy Income Level ($392 a month for one person) is obligated to medical bills as a share of cost, and when that share goes to a nursing home it is paid directly to the facility.1 For more on income eligibility, see Nebraska Medicaid eligibility and income limits.

Medicaid Planning Strategies to Consider

Nebraska's asset and income allowances use the 2026 federal figures, which gives couples a solid baseline. Extra planning matters most when countable assets are well above the $162,660 standard maximum. Options include:2

• Converting countable assets to exempt ones: prepaying burial contracts, making repairs or improvements to the home (the community spouse's residence), or purchasing a vehicle to replace an older one.6
• Medicaid-compliant annuities: some couples turn excess assets into an income stream with an annuity. Under federal law as amended by the Deficit Reduction Act of 2005, buying one counts as a penalized transfer unless the State is named remainder beneficiary, in first position or behind the community spouse or a minor or disabled child. Unless it is a retirement-account annuity, it must also be irrevocable, nonassignable, actuarially sound, and pay equal amounts with no deferral or balloon payment. States can add requirements of their own.3
• Fair hearing: if the income the CSRA generates can't bring the community spouse up to the MMMNA, a fair hearing can raise the resource allowance. The state must first count all of the institutionalized spouse's income that could be made available to her (the "income first" rule).5

For broader options, see Medicaid planning strategies.

Couples with significant assets above the standard maximum should consult a Nebraska-licensed elder law attorney before applying. Getting the asset division right the first time matters.

Where to Get Help

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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.