Nevada Medicaid Spousal Impoverishment 2026: CSRA & MMMNA

Nevada Medicaid spousal impoverishment rules protect the at-home spouse when one partner needs nursing facility care, and Nevada lets that spouse keep the federal maximum.

How Nevada Medicaid Spousal Impoverishment Works

When one spouse enters a nursing facility or qualifies for a home- and community-based services (HCBS) waiver, Nevada applies federal spousal impoverishment protections under 42 USC § 1396r-5. Two sets of rules work together: a resource (asset) protection for the at-home spouse and an income protection.

Nevada is an income-cap state, meaning the institutionalized spouse must have gross monthly income at or below $2,982 (300% of the SSI payment level in 2026); the federal route for income above that is a Miller Trust, covered below. But the income-cap rules for the applicant do not reduce the community spouse's CSRA or income allowance. Those are calculated independently.1

The spouse entering long-term care is the institutionalized spouse. The spouse remaining 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 the community spouse gets to keep when the institutionalized spouse applies for Nevada Medicaid long-term care coverage.2

The Snapshot Date

Nevada still takes a snapshot of the couple's resources. Its manual defines the couple's spousal share as one-half of their total resources, held separately or jointly, at the time of the spouse's institutionalization.1

That snapshot matters less in Nevada than in many states. The spousal share only counts up to the federal maximum, and Nevada already gives the community spouse that maximum automatically (below).

Nevada Allows the Federal Maximum

Nevada does not cut the community spouse down to half the couple's assets. Its Medical Assistance Manual says Nevada "automatically allows the community spouse the maximum federal spousal resource standard," which is $162,660 for 2026.1

The manual's worksheet takes the greatest of four amounts: the state's maximum standard, the couple's spousal share (counted only up to the federal maximum), an amount set in an administrative hearing decision, or an amount set by court order. Because the first one is already the federal maximum, the community spouse keeps up to $162,660 unless a hearing or a court order sets a higher amount.1,2

The 2026 federal minimum resource standard, $32,532, is the lowest standard a state may elect. Nevada elects the maximum instead, so the minimum doesn't come into play for Nevada couples.2

A worked example illustrating the rule:

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 Las Vegas has the following countable assets at the snapshot date: $200,000 in joint savings and $80,000 in the institutionalized spouse's IRA, for a total of $280,000.1

Half of $280,000, the spousal share, is $140,000. Nevada's standard of $162,660 is larger, so the community spouse keeps $162,660.1

That leaves $117,340 on the institutionalized spouse's side. Nevada's applicant asset limit is $2,000, so roughly $115,340 must be spent down before Nevada 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. Countable assets generally include:

• Checking and savings accounts
• CDs and money market funds
• Stocks, bonds, and mutual funds
• Both spouses' IRAs and 401(k)s
• Cash value of life insurance above a modest face-value threshold (confirm the current amount with Nevada DSS)
• Non-home real estate and investment property

Assets that are exempt from the snapshot include the primary home, one vehicle, household goods and personal effects, prepaid burial contracts, and burial plots.

How the MMMNA Works

The Minimum Monthly Maintenance Needs Allowance (MMMNA) is the income protection for the at-home spouse. It is a floor, not a ceiling on her income: the community spouse keeps all of her own income, and the MMMNA is the monthly total that a diversion from the applicant's income must bring her up to. Outside a fair hearing, the $4,066.50 maximum limits that diversion, not what she is allowed to have.2

For 2026, Nevada applies:1

• Floor (minimum MMMNA): $2,705.00/month (effective 7/1/2026 through 6/30/2027)2
• Maximum (federal, same in every state): $4,066.50/month (effective 1/1/2026 through 12/31/2026)2

The $4,066.50 maximum is set federally, the same in every state, and adjusts each January.1

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, say, $4,000/month, she keeps every dollar. This is the "name on the check" rule (42 USC § 1396r-5(b)(2)): income belonging to the community spouse is hers alone.2

Income Diversion

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

How this works: the institutionalized spouse's income is reduced by the Personal Needs Allowance ($154/month in Nevada, deducted before patient liability under Nevada's institutional budgeting), the Medicare Part B premium, and other deductions. From the remainder, enough is diverted to the community spouse to reach the MMMNA floor. The net remaining amount is the patient liability paid to the nursing facility; Nevada Medicaid covers the balance.1

Worked example 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. Confirm the current Medicare Part B premium and your own numbers with Nevada DSS.

Say the community spouse receives $1,000/month from Social Security. The MMMNA floor is $2,705.00/month, so her shortfall is $1,705.00/month. The institutionalized spouse receives $2,500/month from Social Security and a pension. After subtracting the $154 personal needs allowance, the Medicare Part B premium, and any other allowed deductions, a portion of what remains is diverted to the community spouse to reach the $2,705.00/month floor. What is left after the diversion goes to the facility as patient liability, and Nevada Medicaid pays the rest.1

In this illustration the community spouse moves from $1,000/month to the $2,705.00/month floor.2

Reaching the MMMNA Maximum

The community spouse can rise above the $2,705.00 floor, toward the $4,066.50 maximum, when her actual shelter costs (rent or mortgage, property taxes, insurance, and utilities) exceed the federal excess-shelter standard, which is $811.50/month from July 1, 2026. The amount above that standard raises her allowable income. Confirm how your own costs are counted with Nevada DSS.2

Las Vegas and Reno housing costs frequently run high, so many Nevada community spouses have a path to higher income protection through the excess-shelter allowance.

The Home

When the community spouse lives in the home, the federal home-equity limit does not apply at all, so home equity of any amount does not by itself disqualify the spouse applying for Medicaid.3

For 2026 the federal home-equity minimum is $752,000, and a state may elect a higher amount up to $1,130,000. That limit matters only when no spouse, child under 21, or blind or disabled child lives in the home.3 Nevada's own manual still prints an older figure of $713,000, so if the limit could apply to you, confirm the current amount with Nevada DSS.1

Nevada applies the federal 60-month lookback on asset transfers. Transferring the home to a child for less than its value (outside certain exceptions) within that window can create a penalty period.1 Consult a Nevada elder law attorney about caregiver child or disabled child transfer exceptions if protecting the home from eventual estate recovery matters.

Assets That Are Exempt

Beyond the home, these asset categories are excluded from the Medicaid eligibility calculation:

• Primary residence (the federal home-equity limit, $752,000 minimum for 2026, does not apply while the community spouse lives there)3
• One vehicle, regardless of its use or value1
• Household goods and personal effects (furniture, clothing, appliances)
• Prepaid irrevocable burial contracts
• Burial plots for the applicant and immediate family
• Life insurance with a face value at or below the modest threshold Nevada applies (confirm the current amount with DSS)
• Property essential to self-support (working farm or small business tools)

Retirement accounts (IRAs, 401(k)s) held by either spouse are countable in Nevada. Nevada does not offer a special exemption for the community spouse's retirement accounts.

Nevada Medicaid Spousal Impoverishment and the Application Process

Who Administers This

Nevada Medicaid is offered by the Nevada Health Authority, which the 2025 Legislature created through Senate Bill 494, and the Nevada Division of Social Services (DSS) decides eligibility, including for the Medical Assistance to the Aged, Blind and Disabled category that covers long-term care.1 The community spouse's CSRA and MMMNA are calculated as part of the nursing home Medicaid application.

How to Request a Resource Assessment

A couple does not need to file a full Medicaid application to request a resource assessment that records the couple's resources as of the snapshot date. Requesting it at the time of nursing facility admission captures them while documentation is freshest. Applications start at Access Nevada, whose pre-screening tool recommends where to submit your medical assistance application.1

The Miller Trust Dimension

Because Nevada is an income-cap state, an institutionalized spouse whose gross income is over $2,982/month falls outside the nursing-facility category, and none of Nevada's MAABD categories is a medically needy spend-down. The federal route for over-cap income is a Qualified Income Trust (Miller Trust); confirm Nevada's own procedure for setting one up with DSS.1 The community spouse's CSRA and MMMNA are not affected by whether a Miller Trust is in place. Both calculations proceed on the same federal framework regardless. For more on income eligibility, see Nevada Medicaid eligibility and income limits.

The Application Process

Nevada Medicaid long-term care applications follow these general steps. See the Nevada Medicaid how-to-apply guide for a detailed walkthrough.

Where to Get Help

Medicaid Planning Strategies to Consider

Nevada's automatic federal-maximum CSRA gives couples a strong baseline. Additional planning may help when countable assets substantially exceed the $162,660 standard.1 Options include:

• Converting countable assets to exempt ones: prepaying burial contracts, making repairs or improvements to the home, or purchasing a vehicle.
• Community-spouse annuities: an annuity can convert excess assets into an income stream for the community spouse. To avoid a transfer penalty it generally must be irrevocable, nonassignable, actuarially sound, and pay in equal amounts with no deferral or balloon payments, and it must name the State as remainder beneficiary, either first or second after the community spouse or a minor or disabled child.5
• Fair hearing: if the community spouse's income still falls short of the MMMNA after all of the institutionalized spouse's available income is counted toward her, a fair hearing can raise her resource allowance above $162,660 to an amount that generates enough income.2

For broader options, see Medicaid planning strategies.

Couples with assets substantially above $162,660 should consult a Nevada-licensed elder law attorney before applying.1

Learn More

Find personalized help understanding Nevada Medicaid spousal impoverishment rules 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.