Washington Medicaid Spousal Impoverishment 2026: CSRA Guide

Washington Medicaid spousal impoverishment rules protect the at-home spouse, and Washington's $1,130,000 home equity limit is the highest in the country.

How Washington Medicaid Spousal Impoverishment Works

When one spouse enters a nursing facility or qualifies for a home- and community-based services (HCBS) waiver, Washington Medicaid (Apple Health) applies federal spousal impoverishment protections under 42 USC § 1396r-5. These rules divide into two parts: an asset protection for the at-home spouse and an income protection.

Washington is administered by the Washington State Health Care Authority (HCA), with long-term care eligibility processed by the Department of Social and Health Services (DSHS) Home and Community Services. For income eligibility, Washington uses a special income level of $2,982/month, but does not require a Miller Trust: applicants over that level qualify instead through a medically needy spend-down.

The community spouse's asset and income protections are calculated independently from the spend-down rules. The spouse entering long-term care is called the institutionalized spouse. The spouse who remains at home is the community spouse.

How the Washington Medicaid Spousal Impoverishment 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 Washington Medicaid long-term care coverage.

The Snapshot Date

Before Washington 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 enters a nursing facility for a stay of at least 30 continuous days.

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

The Half-of-Assets Formula

Washington applies the federal formula under WAC 182-513-1350: the community spouse keeps half of the couple's total countable assets at the snapshot date, subject to minimum and maximum limits.

For 2026:

• Minimum CSRA: $32,532 (if half the assets is less than this, the community spouse still keeps $32,532)
• Maximum CSRA: $162,660 (if half the assets exceeds this, the community spouse keeps $162,660)

Washington applies the federal maximum, giving Washington couples the most the 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 Seattle has $200,000 in joint savings and a $100,000 brokerage account. Total: $300,000. Half is $150,000, which exceeds the $162,660 ceiling, so the community spouse keeps $162,660.

The institutionalized spouse's countable assets are $300,000 minus $162,660, minus the $2,000 applicant limit, meaning roughly $135,340 must be spent down before Medicaid eligibility is established.

What Counts as a Countable Asset?

Both spouses' assets are pooled 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 $1,500 face value
• Non-home real estate

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

How the Washington Medicaid Spousal Impoverishment MMMNA Works

The Minimum Monthly Maintenance Needs Allowance (MMMNA) is the income protection for the at-home spouse.

For 2026, Washington applies:

• Floor (minimum MMMNA): $2,643.75/month (effective 7/1/2025 through 6/30/2026)
• Ceiling (maximum MMMNA): $4,066.50/month (effective 1/1/2026 through 12/31/2026)

The Name-on-the-Check Rule

Under federal law (42 USC § 1396r-5(b)(2)), the community spouse keeps all of her own income regardless of amount. Income in the community spouse's name does not factor into the applicant's Medicaid eligibility.

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, Washington allows an income diversion from the institutionalized spouse's income to bring the community spouse up to the floor.

The institutionalized spouse's income is reduced by the Personal Needs Allowance ($108.74/month in Washington), Medicare Part B premiums, 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. Washington Medicaid covers the rest.

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 $1,500/month from Social Security. The MMMNA floor is $2,643.75/month. Her shortfall is $1,143.75/month. The institutionalized spouse receives $2,600/month from pension and Social Security. After the $108.74 PNA and a $185 Medicare Part B premium, $2,306.26 is available. Of that, $1,143.75 is diverted to the community spouse. The remaining $1,162.51 goes to the nursing facility. Washington Medicaid covers the rest.

Reaching the MMMNA Ceiling

The community spouse can reach the $4,066.50 ceiling if she has excess shelter costs above the federal shelter standard ($793.13/month for 2026). Actual rent, mortgage, property taxes, homeowners insurance, and utilities exceeding $793.13/month raise the allowable income toward the ceiling. Given the higher housing costs in much of Washington, this provision is especially relevant for Seattle-area families.

Washington's Home Equity Limit: $1,130,000

This is the figure that distinguishes Washington from most states. Most states use the lower federal home equity limit of $752,000. Washington elects the higher CMS-posted maximum, and for 2026 that figure is $1,130,000 (per WAC 182-513-1350, which ties the limit to the CMS-posted maximum each year).

What this means in practice: a community spouse living in a home with equity up to $1,130,000 faces no home-equity disqualification, and the home is fully exempt from Medicaid eligibility calculations. For families in the Puget Sound area or other high-cost Washington markets where home values routinely exceed $750,000, this is a material protection that most other states do not provide.

The home remains subject to Washington's estate recovery program after both spouses have died. If protecting the home from estate recovery is a concern, consult a Washington elder law attorney.

Washington's Spend-Down Model: No Miller Trust Required

Washington does not require a Qualified Income Trust (Miller Trust) for Medicaid long-term care eligibility. Applicants whose income exceeds the $2,982/month special income level qualify instead through the medically needy spend-down, incurring excess income on medical and care costs each month.

This simplifies the application process for Washington families compared to income-cap states. For more on income eligibility, see Washington Medicaid eligibility and income limits.

Assets That Are Exempt

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

• Primary residence (equity up to $1,130,000 while the community spouse lives there)
• One vehicle of any value
• Household goods and personal effects
• Prepaid irrevocable burial contracts
• Burial plots for the applicant and immediate family

Washington Medicaid Spousal Impoverishment and the Application Process

Who Administers This

Washington Medicaid for long-term care is administered by the Washington State Health Care Authority (HCA) through Apple Health, with long-term care eligibility processing by DSHS Home and Community Services. The CSRA and MMMNA are calculated as part of the nursing home Medicaid application.

How to Apply

Apply online through Washington Connection, by phone at 1-877-501-2233, or through a local DSHS Home and Community Services office. For a full walkthrough, see the Washington Medicaid how-to-apply guide.

The general steps:

1. Gather documentation: bank and brokerage statements at the snapshot date, property records, insurance policies, income statements.
2. Apply online, by phone, or at a local DSHS office.
3. DSHS calculates the CSRA and MMMNA and notifies both spouses.
4. Both spouses have the right to appeal any determination.

Medicaid Planning Strategies to Consider

Washington's federal-maximum CSRA, high home equity limit, and no-Miller-Trust model give families strong baseline protections. Cases where additional planning may help:

• Converting countable assets to exempt ones: home improvements, prepaying burial contracts, purchasing a vehicle.
• Community-spouse annuities: converting excess countable assets into an income stream using an irrevocable annuity meeting Deficit Reduction Act 2005 requirements.
• Fair hearing: if the CSRA does not generate enough income to meet the MMMNA, a fair hearing may increase the resource allowance.

For broader options, see Medicaid planning strategies.

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

Learn More

• Washington Medicaid Eligibility and Income Limits
• How to Apply for Washington Medicaid
• Medicaid Planning Strategies

Find personalized help understanding Washington 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.