Washington Medicaid Spousal Impoverishment 2026: CSRA Guide

When one spouse needs Washington Medicaid for long-term care, spousal impoverishment rules let the at-home spouse keep a share of the couple's assets and all of her own income. Washington also elects the federal maximum home equity limit, $1,130,000, rather than the $752,000 federal minimum, and the limit does not apply at all while the applicant's spouse lives in the home.1,2

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 the federal spousal impoverishment protections under 42 U.S.C. 1396r-5.4 These rules split into two parts: an asset protection for the at-home spouse and an income protection.

Washington Medicaid 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 institutional and waiver coverage, Washington uses a Medicaid Special Income Level of $2,982 per month for 2026. An applicant in a medical institution whose income is over that level can still be eligible through the SSI-related medically needy program, provided they meet its other requirements under WAC 182-513-1395.1

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

How the Washington Medicaid CSRA Works

The Community Spouse Resource Allowance (CSRA) is the portion of the couple's countable assets that the community spouse keeps when the institutionalized spouse applies for Washington Medicaid long-term care coverage.3

The Snapshot Date

Before Washington calculates the CSRA, it takes a snapshot of the couple's total countable assets. Federal law computes that total, and the one-half spousal share, as of the beginning of the institutionalized spouse's first continuous period of institutionalization.4

The snapshot fixes the one-half spousal share. Eligibility itself is tested at application, when everything either spouse owns counts as available to the applicant to the extent it exceeds the community spouse's allowance.4

Half the Assets, or Washington's Standard

Under WAC 182-513-1355, Washington allocates to the community spouse the greater of two amounts: half the couple's combined countable resources, capped at the federal spousal resource maximum, or Washington's own state spousal resource standard. The rule applies where the institutionalized spouse's most recent continuous period of institutionalization began on or after August 1, 2003.1

For 2026:

• Washington's floor: $72,529, the state spousal resource standard (the July 1, 2025 figure; HCA's chart notes it changes in odd-numbered years). If half the assets is below this, the community spouse is protected up to $72,529 instead.1
• Cap on the half-share: $162,660, the 2026 federal maximum. If half the assets is above this, the half-share stops at $162,660.1,3

Washington's floor sits well above the $32,532 federal minimum resource standard, so a couple with modest savings keeps more than the federal minimum alone would protect.3 A fair hearing or a court order can set the allowance higher than either figure.3

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, for $300,000 total. Half is $150,000, which is more than Washington's $72,529 standard and below the $162,660 cap, so the community spouse keeps $150,000. The institutionalized spouse's remaining $150,000, minus the $2,000 applicant asset limit, is roughly $148,000 that must be spent down before Medicaid eligibility begins. If the same couple had $100,000 in total, half would be $50,000; Washington's $72,529 standard is larger, so the community spouse could keep up to $72,529.3,1

What Counts as a Countable Asset?

Both spouses' assets are pooled regardless of whose name is on the account.4 Countable assets generally include:

• Checking and savings accounts
• CDs and money market funds
• Stocks, bonds, and mutual funds
• Non-home real estate

Retirement accounts and the cash value of life insurance can also count, so ask DSHS how it treats yours before you assume either is exempt. Assets that are exempt include the primary home, one vehicle used for transportation, and burial funds or an irrevocable burial arrangement.1

How the Washington Medicaid MMMNA Works

The Minimum Monthly Maintenance Needs Allowance (MMMNA) is the income protection for the at-home spouse.3

Washington applies these figures:

• Floor (minimum MMMNA): $2,705.00 per month, effective July 1, 2026 through June 30, 2027.3,1
• Ceiling (maximum MMMNA): $4,066.50 per month, effective January 1, 2026.3,1

The Name-on-the-Check Rule

Under federal law (42 U.S.C. 1396r-5(b)), no income of the community spouse is deemed available to the institutionalized spouse, and income paid solely in the community spouse's name counts only for the community spouse.3 The community spouse keeps all of their own income, whatever the amount; income paid to both spouses is generally split half to each.3

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 first reduced by the Personal Needs Allowance of $108.74 per month.1 The community spouse's allowance is the amount by which the MMMNA exceeds her own income, and it is deducted only to the extent the institutionalized spouse's income is actually made available to her.4 The income left after this post-eligibility calculation goes toward the cost of care, and Washington Medicaid pays the facility the rest.1

A 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.

The community spouse receives $1,500 per month from Social Security. The MMMNA floor is $2,705.00 per month, so the shortfall is $1,205.00.3 The institutionalized spouse receives $2,600 per month from a pension and Social Security. After the $108.74 Personal Needs Allowance is deducted, up to $1,205.00 of the remainder can go to the community spouse to reach the floor, and the balance goes toward the cost of care.1,4

Reaching the MMMNA Ceiling

The community spouse's allowance can rise above the floor, up to the $4,066.50 ceiling, when high housing costs add an excess shelter allowance.3 That allowance counts rent or mortgage (principal and interest), property taxes, homeowners insurance, any condominium or co-op maintenance charge, and the state's standard utility allowance, to the extent they exceed 30 percent of a federal poverty-line amount.4 Washington's July 1, 2026 standards chart lists the community-spouse excess-shelter standard as $812 a month.1 A fair hearing can also raise the allowance above the ceiling when exceptional circumstances cause significant financial duress.3 Confirm how your housing costs apply with DSHS Home and Community Services when you apply; this provision matters most where housing is expensive.

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

This figure distinguishes Washington. Without a state election, the lower federal home equity minimum of $752,000 applies.2 Washington elects the higher federal maximum, which for 2026 is $1,130,000, with WAC 182-513-1350 tying the state limit to the CMS-posted maximum each year.1

Under WAC 182-513-1350(8)(a) the limit does not apply when the applicant's spouse, or a dependent child under 21 or a blind or disabled child, lawfully lives in the home, so a community spouse who stays in the house keeps home equity from disqualifying the applicant at all, however large it is.1 For a single or widowed applicant in a high-cost Washington market, where equity can exceed $752,000, the higher limit is a material protection a state at the federal minimum does not provide.2 An applicant denied for excess home equity can apply for an undue hardship waiver under WAC 182-513-1367.1 Federal law also lets an applicant use a reverse mortgage or home equity loan to bring equity below the limit.2

The home remains subject to Washington's estate recovery program after both spouses have died. Washington is an expanded-estate-recovery state, so if protecting the home from recovery is a concern, read the section below and consult a Washington elder law attorney.5

Income Over $2,982: The Medically Needy Route

Washington's Special Income Level for institutional and waiver Medicaid coverage is $2,982 per month for 2026. A medical-institution resident whose income is higher can still be eligible under the SSI-related medically needy program, provided they meet its other requirements under WAC 182-513-1395.1

The test compares the income left after the post-eligibility calculation with the state-contracted daily rate for the days spent in the facility. If that remaining income plus any excess resources is no more than the state-contracted amount, the agency pays the facility. If remaining income is higher than that but less than the private nursing-facility rate, the resident receives care at the state-contracted rate and qualifies for medically needy coverage for a three- or six-month base period once additional medical expenses in that period exceed remaining income minus the state-contracted rate (the medically needy spenddown). Someone who has excess resources and remaining income above the state-contracted rate does not qualify this way.1

Ask DSHS Home and Community Services how this calculation applies before you assume income rules your spouse out. For more on income eligibility, see Washington Medicaid eligibility and income limits.

Assets That Are Exempt

Washington excludes these assets from the Medicaid eligibility calculation:1

• Primary residence: the $1,130,000 equity limit does not apply while the community spouse lives there.1
• One vehicle: excluded regardless of value when it is used to transport the applicant or a household member.1
• Burial funds: revocable burial funds up to $1,500 for the applicant and $1,500 for the spouse, plus an irrevocable burial arrangement set aside solely for burial expenses.1

Estate Recovery: The Home Is Not Automatically Safe

Spousal impoverishment protects the community spouse while both spouses are alive, but Washington's estate recovery program can seek repayment after both have died. A common and costly misconception is that Washington only recovers from probate assets. That is wrong: Washington is an expanded-estate-recovery state. Under RCW 43.20B.080, the state seeks recovery from the recipient's estate "and from nonprobate assets of the individual as defined by RCW 11.02.005," which includes joint tenancy with right of survivorship, payable-on-death and transfer-on-death accounts and deeds, community property agreements, life estates, and death-triggered living trusts.5 The same definition leaves out the payable-on-death provision of a life insurance policy, an annuity, or an employee benefit plan.5 Recovery is also limited in scope: it covers nursing facility services, home and community-based services, other services the department determines to be appropriate, and related hospital and prescription drug services, received at age 55 or older.5

Recovery is deferred while a surviving spouse, a surviving child age 20 or younger, or a surviving child of any age who is blind or disabled is alive.5 Federal law also requires an undue-hardship process, but Washington implements it under WAC 182-527-2750 as a delay of recovery rather than forgiveness, and limits it to narrow cases: the property is an heir's sole income-producing asset, recovery would deprive an heir of shelter they cannot otherwise afford, or the recipient is survived by a state-registered domestic partner.5 For the full picture, see Washington Medicaid estate recovery.

Washington Medicaid Spousal Impoverishment: The Application Process

Washington Medicaid for long-term care is administered by the Washington State Health Care Authority (HCA) through Apple Health, with long-term care eligibility processed by DSHS Home and Community Services. The CSRA and MMMNA are calculated as part of the nursing home Medicaid application. Apply online through Washington Connection, by phone at 1-877-501-2233, or through a local DSHS Home and Community Services office.1 For a full walkthrough, see the Washington Medicaid how-to-apply guide.

Medicaid Planning Strategies to Consider

Washington's $72,529 state floor, federal-maximum cap on the half-share, and high home equity limit give families strong baseline protections.1 Cases where additional planning may help:

• Converting countable assets to exempt ones: home improvements, prepaying an irrevocable burial arrangement, or buying a vehicle the household needs for transportation.1
• Community-spouse annuities: converting excess countable assets into an income stream using an annuity that meets the federal annuity rules amended by the Deficit Reduction Act of 2005, including naming the State as a remainder beneficiary.5
• Fair hearing: if the CSRA does not generate enough income to meet the MMMNA, a fair hearing may increase the resource allowance.3

For broader options, see Medicaid planning strategies. Couples with assets well above the CSRA ceiling should consult a Washington-licensed elder law attorney before applying.

Where to Get Help

If you are working through a Washington Medicaid application for a spouse in long-term care, start with these resources.

Learn More

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.