Ohio Spousal Impoverishment (2026): CSRA & MMMNA Guide

Ohio spousal impoverishment rules stand between your family and financial ruin when one spouse needs nursing facility care or an HCBS waiver and the other stays home.1 The federal rules at 42 USC 1396r-5 set aside part of the couple's savings and part of the institutionalized spouse's income for the spouse who stays home, and a State Hearing or a court order can set either amount higher than the standard figures.2 Ohio's long-term care resource requirements sit in OAC 5160:1-6-04 and OAC 5160:1-3-05.1, and the Ohio Department of Medicaid publishes the yearly dollar figures that feed the math.3,4

Key Takeaways

• The federal authority is 42 USC 1396r-5.2 Federal law currently extends the protections to married people eligible for home- and community-based services through September 30, 2027, so a spouse on PASSPORT, the Assisted Living Waiver, the Ohio Home Care Waiver or MyCare Ohio is covered as well as a nursing facility resident.1
• Ohio's 2026 resource standards for the Community Spouse Resource Allowance (CSRA) are $32,532 (minimum) and $162,660 (maximum).4 They are standards, not a cap on what the community spouse can keep. The protected amount is the greatest of (a) the $32,532 minimum, (b) one-half of total countable resources on the snapshot date, up to $162,660, or (c) an amount set by a State Hearing decision or a court order, which can exceed $162,660.2 The applicant spouse can keep $2,000 in countable assets (the $3,000 figure applies only when both spouses are applying).4
• The Minimum Monthly Maintenance Needs Allowance (MMMNA) is $2,705.00 a month from July 1, 2026 through June 30, 2027, and the standard maximum is $4,066.50 a month from January 1, 2026.2 These figures size the Community Spouse Monthly Income Allowance (CSMIA): the amount by which the MMMNA, including any excess shelter allowance, exceeds the community spouse's own monthly income. They do not limit the community spouse's own income.4
• The Excess Shelter Allowance can raise the MMMNA above the $2,705.00 minimum when the community spouse's housing costs exceed the excess-shelter standard of $811.50 a month.2 Under the standard formula, the shelter-adjusted MMMNA stops at the $4,066.50 maximum.4
• A State Hearing or a court order can set either allowance above the standard figures. A hearing can raise the CSRA when the standard allowance cannot generate enough income to bring the community spouse up to the MMMNA, and can raise the income allowance when exceptional circumstances cause significant financial duress. A court order for spousal support sets the income allowance at no less than the ordered amount.2,4
• The income-first rule limits raised-CSRA cases. Before a hearing can protect extra resources, all of the institutionalized spouse's income that could be made available to the community spouse is treated as already made available. Federal law makes this rule mandatory, so it applies in Ohio.2
• A Miller Trust is a separate tool for an institutionalized spouse whose countable income is above the 2026 Special Income Limit of $2,982: Ohio's rule says that person may set up a qualified income trust to bring countable income to or below the limit.4 When there is a trust, a maintenance allowance for the spouse is one of the monthly distributions it makes.5

Why Ohio spousal impoverishment rules exist

The point of these rules is that the spouse who stays home should not be left with nothing when the other spouse's care is paid for. The rules codified at 42 USC 1396r-5 establish two protections:

Resource protection. A portion of the couple's combined countable resources is set aside for the community spouse and kept out of the institutionalized spouse's Medicaid asset calculation. The protected amount is the Community Spouse Resource Allowance (CSRA).2

Income protection. While the institutionalized spouse is in the institution, none of the community spouse's own income is deemed available to the institutionalized spouse.2 On top of that, part of the institutionalized spouse's income is reserved for the community spouse's support. The reservation amount is the Community Spouse Monthly Income Allowance (CSMIA), calculated against the Minimum Monthly Maintenance Needs Allowance (MMMNA).4

The rules started with nursing facility care. For home- and community-based services, Section 5115 of the Consolidated Appropriations Act, 2023 extended the spousal impoverishment protections to all married individuals eligible for those services under the specified authorities, through September 30, 2027.1 That end date is set in federal law, so check whether Congress has extended it if your spouse's waiver case runs past it.

In Ohio, the Department of Medicaid lists the year's CSRA standards in its annual COLA letter (MEPL 191 for 2026) and on its Medicaid Standards Help Sheet.4 Applications are filed through the County Department of Job and Family Services (CDJFS) or the state's other application channels.6

The snapshot date: why it matters so much

The CSRA starts from one-half of the couple's combined countable resources, and that half-share is measured at a fixed point in time, often called the snapshot date, rather than whenever the county gets around to looking.2 Because the date decides the size of the half-share, ask your CDJFS caseworker which date it used for your case and get the resource figures it used in writing.

Two rules work alongside it:

• Transfers in the 60 months before applying can be penalized. Giving assets away for less than fair market value inside the 60-month look-back can trigger a penalty period under 42 USC 1396p(c)(1) and Ohio's rules at OAC 5160:1-6-06 and OAC 5160:1-6-06.5, during which Medicaid will not pay for long-term care.7
• Transfers between spouses are not penalized. Assets transferred to the individual's spouse, or to another person for the spouse's sole benefit, are not treated as improper transfers.7 Moving an account into the community spouse's name does not take it out of the couple's combined total, though.

How much of the couple's savings can the community spouse keep?

Under 42 USC 1396r-5(f), the Community Spouse Resource Allowance is calculated using the following sequence:

Step 1: Identify the couple's countable resources. Countable resources are what remains after Ohio's exclusions are applied. Those exclusions sit in other rules of OAC Chapter 5160:1-3, so ask your county which of your assets it excludes before you add anything up.3

Step 2: Divide total countable resources in half. The community spouse's protected share starts at half of the couple's total countable resources on the snapshot date.2

Step 3: Apply Ohio's minimum and maximum resource standards. ODM lists the 2026 minimum and maximum CSRA at the federal standards of $32,532 and $162,6604:

• Minimum standard: $32,532. If half of countable resources is less than $32,532, the community spouse is protected up to the minimum.
• Maximum standard: $162,660. If half of countable resources exceeds $162,660, the half-share counts only up to $162,660.
• In between: If half of countable resources falls between $32,532 and $162,660, the community spouse keeps that half-share.

Step 4: Apply any higher amount set by a State Hearing or court order. Under 42 USC 1396r-5(e)(2)(C), a hearing can substitute a CSRA large enough to generate the income that brings the community spouse up to the MMMNA, after the income-first rule is applied. Under 1396r-5(f)(3), a court order can transfer a larger amount. Either route can exceed $162,660, because the statute attaches no dollar limit to them.2

Step 5: Determine the institutionalized spouse's available resources. Total countable resources minus the CSRA equals the institutionalized spouse's available resources. The institutionalized spouse's resource limit for Medicaid eligibility is $2,000 (individual).4 Anything above $2,000 has to come down before eligibility begins.

Worked example #1: CSRA set by the half-share

The Wilsons have combined countable resources of $180,000 on the snapshot date. Half is $90,000, which falls between $32,532 and $162,660.2

• Community Spouse CSRA: $90,000
• Institutionalized Spouse's available resources: $180,000 - $90,000 = $90,000
• Spend-down to eligibility: $90,000 - $2,000 = $88,000 must come down before Medicaid eligibility begins. Spending it for fair value, such as on care, is not a transfer; giving it away for less than fair market value inside the 60-month look-back can trigger a penalty.7

Worked example #2: CSRA at the minimum

The Diazes have combined countable resources of $40,000 on the snapshot date. Half is $20,000, below the minimum of $32,532.2

• Community Spouse CSRA: $32,532 (minimum applied)
• Institutionalized Spouse's available resources: $40,000 - $32,532 = $7,468
• Spend-down to eligibility: $7,468 - $2,000 = $5,468 must be spent down.

Worked example #3: CSRA at the maximum

The Andersons have combined countable resources of $600,000 on the snapshot date. Half is $300,000, above the maximum of $162,660.2

• Community Spouse CSRA: $162,660 (maximum standard applied) unless a State Hearing or court order sets a higher amount
• Institutionalized Spouse's available resources: $600,000 - $162,660 = $437,340
• Spend-down to eligibility: $437,340 - $2,000 = $435,340 must be spent down or restructured. At this asset level, talk to an elder-law attorney before moving any money: federal law treats buying an annuity as a transfer for less than fair market value unless the annuity meets strict conditions (see the FAQ below).5

CSRA scenarios at a glance

The three worked examples above show how the same half-rule produces very different outcomes depending on the couple's total resources. All figures use Ohio's 2026 resource standards.2

How much monthly income can the community spouse keep?

The income side of spousal impoverishment operates separately from the resource side, with its own minimum, its own maximum, and its own shelter cost adjustment.

Minimum MMMNA. From July 1, 2026 through June 30, 2027, the federal minimum MMMNA is $2,705.00 per month.2

Maximum MMMNA. The standard maximum is $4,066.50 per month from January 1, 2026.2 It limits the shelter-adjusted MMMNA under the standard formula, not the community spouse's own income, and a State Hearing or court order can set the income allowance higher (see below).4

Excess Shelter Allowance. The MMMNA can be raised above the minimum (up to the standard maximum) when the community spouse's shelter costs exceed the excess-shelter standard of $811.50 a month.2 Ask your county which housing and utility costs it counts, and bring the bills. The calculation:

• Shelter threshold = the excess-shelter standard, $811.50 a month from July 1, 2026
• Excess Shelter Allowance (ESA) = shelter costs minus the excess-shelter threshold, if positive
• Adjusted MMMNA = MMMNA minimum + ESA, up to the standard MMMNA maximum

The Community Spouse Monthly Income Allowance (CSMIA) is the amount by which the applicable MMMNA exceeds the community spouse's own monthly income. It is deducted from the institutionalized spouse's monthly income before the rest is applied to the cost of care, but only to the extent the institutionalized spouse's income is actually made available to the community spouse.4 The formula:

CSMIA = MMMNA - community spouse's own monthly income

If the community spouse's own income already meets or exceeds the MMMNA, the CSMIA is zero and no income is diverted. If the community spouse has no income of their own, the CSMIA equals the full MMMNA.

For institutionalized spouses with countable income above the 2026 Special Income Limit of $2,982 who set up a Miller Trust, the spouse's maintenance allowance is one of the monthly distributions from the trust.4,5

The worked examples below are illustrative. They use the MMMNA minimum ($2,705.00), the standard maximum ($4,066.50) and the $811.50 excess-shelter standard in effect from July 1, 20262, with each family's shelter costs given as a total. Confirm the current figures with your county Department of Job and Family Services before relying on any dollar result.

Worked example #4: MMMNA, no shelter adjustment

Mrs. Patel is the community spouse. Her own monthly income (Social Security) is $1,200. Her shelter costs total $700 per month. Her shelter cost falls below the $811.50 excess-shelter standard, so no ESA applies.2

• Applicable MMMNA: $2,705.00 (minimum)
• CSMIA: $2,705.00 - $1,200 = $1,505.00 diverted from the institutionalized spouse's income to Mrs. Patel each month
• Mr. Patel (institutionalized) keeps his personal needs allowance, the CSMIA goes to Mrs. Patel, and after health insurance premiums and the other deductions Ohio's rule allows, the rest of his income is patient liability.8

Worked example #5: MMMNA with Excess Shelter Allowance

Mrs. Hartman is the community spouse. Her own monthly income is $900. Her shelter costs total $1,650 per month.2

• Her shelter costs exceed the $811.50 excess-shelter standard, so an ESA is added: $1,650 - $811.50 = $838.50.
• Adjusted MMMNA: $2,705.00 + $838.50 = $3,543.50, which is below the $4,066.50 standard maximum and so applies as calculated.
• CSMIA: $3,543.50 - $900 = $2,643.50 diverted from the institutionalized spouse to Mrs. Hartman each month.

Worked example #6: MMMNA at the standard maximum

Mr. Solomon (community spouse) has shelter costs of $3,500 per month and own income of $500. His ESA ($3,500 - $811.50 = $2,688.50) would push the adjusted MMMNA to $5,393.50, above the standard maximum, so the maximum controls.2

• Applicable MMMNA: $4,066.50 (the standard maximum)
• CSMIA: $4,066.50 - $500 = $3,566.50 (the most the standard formula allows)
• Note: To go above $4,066.50, Mr. Solomon would need a State Hearing decision finding exceptional circumstances that cause significant financial duress, or a court order for spousal support. A raised CSRA is a separate route, open only if, after the income-first rule, the income available to him still falls short of the MMMNA.4

Raising the MMMNA via State Hearing

When the standard MMMNA calculation (including the Excess Shelter Allowance up to the maximum) leaves the community spouse unable to meet their actual living expenses, the community spouse can ask for a higher allowance through a State Hearing.

The test for going above the standard figure. Either spouse who disagrees with the income allowance is entitled to a hearing. If either spouse shows that the community spouse needs more income than the MMMNA provides because of exceptional circumstances resulting in significant financial duress, the hearing substitutes an amount adequate to provide that income.2 Documented costs, such as housing or medical bills, are the evidence for that showing. A court order works differently: where a court has ordered the institutionalized spouse to pay support to the community spouse, the income allowance is no less than the ordered amount.4

Keeping benefits at the current level while the appeal is pending runs on a shorter clock: a recipient whose benefits will be reduced, stopped, or restricted must request the hearing within 15 days of receiving that notice, and continuation can end in some circumstances. To request a hearing, call or write your county agency, or mail or fax the request form that came with the notice to the Ohio Department of Job and Family Services Bureau of State Hearings. The Bureau's toll-free line, 1-866-635-3748, is for asking to join the hearing by phone or whether benefits should be continuing.9

Raising the CSRA via State Hearing

The CSRA can also be raised above the $162,660 standard maximum through a State Hearing under federal law at 42 USC 1396r-5(e)(2)(C), when the standard allowance cannot generate enough income to bring the community spouse up to the MMMNA.2 The income-first rule decides how often that happens.

The income-first rule. Under 42 USC 1396r-5(d)(6), a state must treat all of the institutionalized spouse's income that could be made available to the community spouse as already made available before it protects additional resources. The rule is mandatory, so it applies in Ohio.2 In practice:

• First, the institutionalized spouse's available income is counted toward bringing the community spouse up to the MMMNA
• Second, only if that income still leaves the community spouse short of the MMMNA can additional resources be protected beyond the standard CSRA

So a raised CSRA is realistic mainly when the institutionalized spouse's income, even if all of it went to the community spouse, would still leave the community spouse below the MMMNA.

Do the rules apply if my spouse gets care at home on a waiver?

Yes, for now. Federal law extends the spousal impoverishment protections to married individuals eligible for home- and community-based services through September 30, 2027.1 Ohio's patient-liability rule for waiver participants, OAC 5160:1-6-07.1, deducts a monthly income allowance for a community spouse in the same way the nursing facility rule does.10

The table summarizes the four waivers; the paragraphs after it give the source for each row.

PASSPORT Waiver. PASSPORT serves people 60 or older at enrollment who meet a nursing-facility level of care. The Ohio Department of Aging runs it day to day, and the Area Agencies on Aging, as its designees, employ the case managers.3 The participant keeps the $1,939 SIMNA before the community spouse allowance is deducted.10

Assisted Living Waiver. The waiver pays the residential care facility for the service package but never for room and board, which the resident pays from income, capped at the SSI federal benefit rate minus $50. In the patient-liability calculation the resident first keeps the $994 ALMNA, which covers room and board, and the community spouse allowance comes out after that.10

Ohio Home Care Waiver. OHCW serves Ohioans from birth through age 59 with a nursing-facility level of care, and ODM runs it.11 Because participants are under 60, the community spouse may still be working, and a spouse whose own income meets or exceeds the MMMNA gets no CSMIA.4

MyCare Ohio Waiver. Next Generation MyCare covers Ohioans 21 and older with both full Medicaid and Medicare, through integrated plans.12 A MyCare waiver participant living in the community keeps the $1,939 SIMNA, and the same community spouse deduction follows.10

Family member allowances under 42 USC 1396r-5(d)(1)(C) can also apply when minor or dependent children, dependent parents, or dependent siblings of either spouse live with the community spouse. Each family member's allowance is at least one-third of the amount by which the MMMNA exceeds that family member's own monthly income, and it is deducted in addition to the community spouse's allowance.2

How spousal impoverishment interacts with the Miller Trust

When the institutionalized spouse's countable income is above the 2026 Special Income Limit of $2,982, Ohio's rule lets them set up a Miller Trust to bring countable income to or below that limit, in addition to spousal impoverishment planning.4 The two operate together.

Sequence of operations each month:

1. Only the institutionalized spouse's own income goes into the Miller Trust account5
2. Income is applied in the order Ohio's patient-liability rule (OAC 5160:1-6-07) sets
3. PNA kept by the institutionalized spouse for personal use ($75 a month for a nursing-facility resident; $1,939 for most HCBS waiver participants, or $994 on the Assisted Living Waiver)8,10
4. CSMIA paid to community spouse to bring them up to the applicable MMMNA
5. A family allowance, if dependent family members live with the community spouse
6. Health insurance premiums (including Medicare premiums)
7. Medical expenses recognized under Ohio law but not covered by Medicaid or a third party
8. Up to $15 a month to administer the trust
9. Remaining balance paid as patient liability to the NF (or toward the cost of waiver services)8

The trust has to make its distributions in that set order no later than the last day of the month the income goes in, and the family has to show the monthly deposits at the annual renewal or on request.5

What spousal impoverishment does NOT do

Spousal impoverishment provides specific resource and income protections but does not solve every problem married couples face under Ohio LTC Medicaid. Some common misunderstandings:

It does not eliminate the 60-month lookback.7 Ohio's transfer rules reach assets given away by the institutionalized individual or by the individual's spouse, so moving money to children or other third parties to "preserve" it for the community spouse can still be penalized. Transfers to the spouse, or to a trust for a blind or disabled child or a disabled person under 65, are among the transfers Ohio does not treat as improper. See OAC 5160:1-6-06.5.7

It does not protect the home from estate recovery automatically. Ohio recovers only after the death of a surviving spouse, but that delays recovery rather than ending it. After the community spouse dies, Ohio's expanded recovery rules at Ohio Revised Code 5162.21 can reach the home, including property passed through joint tenancy, survivorship, a life estate or a living trust.5 See /medicaid/ohio/estate-recovery.

It does not increase the institutionalized spouse's asset limit. The institutionalized spouse still has only the $2,000 individual asset limit for Medicaid eligibility.4 The CSRA shelters the community spouse's portion; it does not let the institutionalized spouse retain extra assets.

Common math mistakes in Ohio spousal impoverishment

Check the county's numbers against these errors:

Counting only assets in the institutionalized spouse's name. The half-share is figured from the couple's combined countable resources, not just what is titled to one spouse.2 Retitling an account to the community spouse does not trigger a transfer penalty, because transfers between spouses are not improper, but it does not take the account out of the total either.7

Confusing the half-rule with the maximum. The protected amount is the greatest of (a) the $32,532 minimum, (b) one-half of countable resources, counted only up to $162,660, or (c) an amount set by a State Hearing or court order, which can exceed $162,660.2 If half of countable resources is $50,000, the CSRA is $50,000, not $162,660 and not $32,532.

Not applying the Excess Shelter Allowance when shelter costs justify it. A CSMIA figured on the $2,705.00 minimum is too low if the community spouse's housing costs exceed the $811.50 excess-shelter standard.2 The community spouse should document shelter costs and ask for the ESA explicitly.

Counting community spouse income against the institutionalized spouse. The community spouse's own income is not deemed available to the institutionalized spouse.2 Only the institutionalized spouse's income is subject to the patient liability calculation.

Missing the family member allowance. Minor or dependent children, dependent parents, or dependent siblings of either spouse who live with the community spouse can each support a family allowance under 42 USC 1396r-5(d)(1)(C).2

Failing to coordinate the Miller Trust with the CSMIA. When a married applicant with income above the SIL uses a Miller Trust, the spouse's maintenance allowance is one of the trust's monthly distributions.5 A trustee who skips it throws off the patient liability calculation.

Missing the income-first rule on raised CSRA. The federal income-first rule counts the institutionalized spouse's available income toward the MMMNA before any additional resources can be protected, which sharply limits when a raised CSRA is possible.2

Practical guidance for families

Arranging long-term care for a husband or wife is one of the hardest things a family goes through, and the fear of losing the home or the savings you built together is real. The rules on this page exist so that the spouse at home does not have to face that loss alone.

The most useful first step for couples approaching Ohio LTC Medicaid: talk to an Ohio elder-law attorney early, and ask your CDJFS how it will total the couple's resources before you file.

Other practical guidance:

Keep the dates on paper. Hospital admission records, nursing facility admission paperwork and HCBS waiver application receipts show when care began. Preserve them and give copies to your attorney and the county.

Inventory all assets thoroughly. List every account, property, brokerage holding, life insurance policy with cash value, retirement account and vehicle, and let the county apply the exclusions. A missed account can delay or derail the application.

Understand the difference between assets and income. The community spouse retains specified assets (CSRA) and specified income (MMMNA and CSMIA).4 These are separate protections with separate rules. Confusing the two leads to math errors.

Plan for the death of the community spouse. Anything that passes to the institutionalized spouse by will or beneficiary designation has to fit under that spouse's $2,000 asset limit,4 so review the community spouse's will and beneficiary designations with an attorney.

Coordinate with the Miller Trust if you set one up. The trust makes its distributions, including the spouse's allowance, in a set order each month.5 The trustee needs to understand and execute the coordination.

Key statutes, rules, and authorities

• 42 USC 1396r-5 (federal spousal impoverishment, including CSRA, MMMNA, CSMIA, and family member allowance)2
• 42 USC 1396p(c)(1) (60-month transfer lookback)7
• 42 USC 1396p(d)(4)(B) (Miller Trust, for coordination)5
• 42 USC 1396p(f) (home equity limit)7
• 42 CFR 435.726 (post-eligibility treatment of income for home- and community-based services)10
• OAC 5160:1-6-04 (resource requirements, applied with OAC 5160:1-3-05.1)3
• OAC 5160:1-6-03.1 (Special Income Limit, for Miller Trust threshold)4
• OAC 5160:1-6-03.2 (Qualified Income Trust)5
• OAC 5160:1-6-06 (improper transfers and the look-back)7
• OAC 5160:1-6-06.5 (restricted Medicaid coverage period for improper transfers)7
• OAC 5160:1-6-07 (Personal Needs Allowance and post-eligibility income)8
• OAC 5160:1-6-07.1 (patient liability for HCBS waiver participants)10
• OAC Chapter 5160-31 (PASSPORT)3
• OAC Chapter 5160-33 (Assisted Living Waiver)10
• OAC Chapter 5160-46 (Ohio Home Care Waiver)11
• OAC Chapter 5160-58 (MyCare Ohio)12
• OAC 5101:6-3-02 (time limit to request a state hearing)9
• Ohio Revised Code 5162.21 (Medicaid estate recovery, for community-spouse-death scenarios)5
• ODM MEPL 191 (2026 COLA letter, including the minimum and maximum CSRA and the MMMNA cap)4
• ODM 2026 Medicaid Standards Help Sheet (protected resource amount minimum and maximum, MMMNA maximum)4

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.