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 income. Washington's $1,130,000 home equity limit is also 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 the federal spousal impoverishment protections under 42 U.S.C. 1396r-5. 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, but it does not require a Qualified Income Trust (Miller Trust): an applicant over that level qualifies instead through the medically needy spend-down.1

The community spouse's asset and income protections are calculated separately from the spend-down. 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.1

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 follows 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 a floor and a ceiling.1

For 2026:

• Minimum CSRA: $32,532. If half the assets is below this, the community spouse still keeps $32,532.1
• Maximum CSRA: $162,660. If half the assets exceeds this, the community spouse keeps $162,660.1

Washington sets its ceiling at the federal maximum of $162,660, so couples get the most the law allows before the ceiling caps the allowance.1

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 below the $162,660 ceiling, 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.1

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 value1
• Non-home real estate

Assets that are exempt include the primary home, one vehicle, household goods and personal effects, and prepaid burial contracts.1

How the Washington Medicaid MMMNA Works

The Minimum Monthly Maintenance Needs Allowance (MMMNA) is the income protection for the at-home spouse.1

For 2026, Washington applies:

• Floor (minimum MMMNA): $2,705.00 per month, effective July 1, 2026 through June 30, 2027.1
• Ceiling (maximum MMMNA): $4,066.50 per month, effective January 1, 2026 through December 31, 2026.1

The Name-on-the-Check Rule

Under federal law (42 U.S.C. 1396r-5(b)(2)), the community spouse keeps all of their 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 of $108.74 per month, any Medicare premiums, and other allowed deductions; from the remainder, enough is diverted to the community spouse to reach the MMMNA floor.1 What is left is the patient liability, paid to the nursing facility, and Washington Medicaid covers the rest.

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 $1,205.00.1 The institutionalized spouse receives $2,600 per month from a pension and Social Security. After the $108.74 Personal Needs Allowance and the spouse's Medicare premiums are deducted, most of the remainder is available to divert; enough is sent to the community spouse to reach the floor, and the balance becomes the patient liability paid to the nursing facility.1

Reaching the MMMNA Ceiling

The community spouse can reach the $4,066.50 ceiling when high housing costs raise the allowance through an excess shelter deduction.1 Actual rent or mortgage, property taxes, homeowners insurance, and a utility standard above a federally set shelter baseline increase the allowable income toward the ceiling. Because that shelter baseline is reset each year, confirm the current figure and how your housing costs apply with DSHS Home and Community Services when you apply. Given the higher housing costs in much of Washington, this provision matters most for Seattle-area families.

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

This figure distinguishes Washington from most states. Most states use the lower federal home equity minimum of $752,000.2 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

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.1 For families in the Puget Sound area or other high-cost Washington markets where home values routinely exceed $752,000, this is a material protection that most other states do not provide.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.3

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. An applicant whose income exceeds the $2,982 per month Special Income Level qualifies instead through the medically needy spend-down, incurring excess income on medical and care costs each month.1

This simplifies the application compared with income-cap states that require a trust. 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:1

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

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.3

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, and a federally required undue-hardship waiver may apply.3 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 federal-maximum CSRA ceiling, 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 an irrevocable burial contract, or purchasing a needed vehicle.
• Community-spouse annuities: converting excess countable assets into an income stream using an irrevocable annuity that meets Deficit Reduction Act of 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 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.