Nevada Medicaid Spousal Impoverishment 2026: CSRA & MMMNA

Nevada Medicaid spousal impoverishment rules protect the at-home spouse when one partner needs nursing facility care, with Nevada applying the federal maximum asset and income protections.

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), or use a Miller Trust for the excess. But the income-cap rules for the applicant do not reduce the community spouse's CSRA or income allowance. Those are calculated independently.3

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.1

The Snapshot Date

Before Nevada calculates the CSRA, the program takes a snapshot of the couple's total countable assets. The snapshot date is the first day of a continuous period of institutionalization, typically the date the institutionalized spouse is admitted to a nursing facility for a stay of at least 30 continuous days.

The snapshot date matters because the CSRA is based on that fixed figure, not on the couple's current asset position at the time of the Medicaid application.

The Half-of-Assets Formula

Nevada applies a straightforward formula: the community spouse keeps half of the couple's total countable assets at the snapshot date, subject to federal minimum and maximum limits.3

For 2026:

• Minimum CSRA: $32,532 (if half the couple's assets falls below this, the community spouse still keeps $32,532)1
• Maximum CSRA: $162,660 (if half the couple's assets exceeds this, the community spouse keeps $162,660)1

Nevada applies the federal maximum, giving Nevada couples the most protection federal law allows.

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 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 is $140,000. That falls between the $32,532 floor and the $162,660 ceiling, so the community spouse keeps $140,000.1

The institutionalized spouse's share is $140,000. Nevada's applicant asset limit is $2,000, so roughly $138,000 must be spent down before Nevada Medicaid eligibility is established.3

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 DWSS)
• 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 sets the floor and ceiling on how much monthly income the community spouse may keep.1

For 2026, Nevada applies:3

• Floor (minimum MMMNA): $2,705.00/month (effective 7/1/2026 through 6/30/2027)1
• Ceiling (maximum MMMNA in Nevada): $4,066.50/month (effective 1/1/2026 through 12/31/2026)1

Nevada applies the federal maximum ceiling of $4,066.50/month.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.1

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.3

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 DWSS.

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.3

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

Reaching the MMMNA Ceiling

The community spouse can reach the $4,066.50 ceiling when her actual shelter costs (rent or mortgage, property taxes, insurance, and utilities) exceed a federal shelter standard. When they do, the excess raises her allowable income toward the ceiling. The exact shelter-standard figure is set federally and adjusts periodically, so confirm the current amount and how it applies to your situation with Nevada DWSS.1

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

The primary residence is exempt from Medicaid eligibility calculations as long as it is the community spouse's principal residence. The home's equity is not counted as a resource.3

For 2026, the federal home equity minimum that Nevada applies is $752,000. Because the community spouse lives in the home, the equity cap rarely becomes an issue.2

Nevada applies a 60-month lookback on asset transfers. Transferring the home to a child (outside certain exceptions) within that window can create a penalty period. 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 (federal equity minimum of $752,000 for 2026 while the community spouse lives there)2
• One vehicle of any value used for transportation of either spouse
• 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 DWSS)
• 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 for long-term care is administered by the Nevada Division of Health Care Financing and Policy (DHCFP), with eligibility handled by DWSS. 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 locks in the snapshot date. Requesting it at the time of nursing facility admission preserves the snapshot when documentation is freshest. Apply at accessnevada.dwss.nv.gov or by phone.3

Long-term care facilities are required by federal law to inform residents and their spouses of the right to request this assessment.

The Miller Trust Dimension

Because Nevada is an income-cap state, if the institutionalized spouse's gross income exceeds $2,982/month, a Qualified Income Trust (Miller Trust) is required.3 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 federal-maximum CSRA and MMMNA give couples a strong baseline. Cases where additional planning may help include situations where countable assets substantially exceed the $162,660 CSRA ceiling.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 irrevocable, non-assignable, actuarially sound annuity can convert excess assets into an income stream for the community spouse. Must meet Deficit Reduction Act 2005 requirements, including naming Nevada as primary remainder beneficiary.
• Fair hearing: if the CSRA alone does not generate enough income to reach the MMMNA, a fair hearing can result in a higher resource allowance based on the community spouse's income shortfall.

For broader options, see Medicaid planning strategies.

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

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.