West Virginia Medicaid Spousal Impoverishment 2026: CSRA Guide

West Virginia Medicaid spousal impoverishment rules protect the spouse who stays home when the other enters long-term care. In 2026, the at-home (community) spouse can keep between $32,532 and $162,660 in countable assets and an income floor of $2,705.00 per month. This guide explains how those protections work through West Virginia Medicaid, and why the state does not require a Miller Trust.1

What West Virginia Medicaid Spousal Impoverishment Rules Cover

When one spouse needs nursing-facility care or a home- and community-based services (HCBS) waiver, the couple must meet strict asset and income limits before Medicaid will pay. Without protection, the healthy spouse who stays home could be left nearly penniless while paying for a partner's care. Federal spousal impoverishment law, codified at 42 U.S.C. 1396r-5 (Section 1924 of the Social Security Act), prevents that by reserving a share of the couple's resources and income for the community spouse.1

West Virginia applies these federal rules through the West Virginia Department of Human Services (DoHS) Bureau for Medical Services, which administers Medicaid and sets eligibility policy under the state's Income Maintenance Manual. The two protections are the Community Spouse Resource Allowance (CSRA) on assets and the Minimum Monthly Maintenance Needs Allowance (MMMNA) on income. The spouse who enters long-term care is the institutionalized spouse; the spouse who remains at home is the community spouse.1

These protections apply only to West Virginia's long-term-care pathways: Nursing Facility Medicaid and the state's HCBS waivers. They do not apply to medical-only Aged, Blind, and Disabled Medicaid, MAGI categories, or Medicare Savings Programs, which use different eligibility rules.

The Snapshot Date

Every spousal impoverishment calculation starts from the snapshot date: the first day of a continuous period of institutionalization lasting at least 30 days. This is usually the date of nursing-facility admission, or the date a hospital admission leads into a 30-day-or-longer nursing stay.

The snapshot date matters because all countable assets of both spouses are valued as of that date, no matter how much later the Medicaid application is filed. Renaming a joint account into the community spouse's name after the snapshot date does not change the snapshot-date count. Preserve bank, brokerage, and asset statements dated on or near the snapshot date, because DoHS uses them to set the CSRA.1

The West Virginia Medicaid Spousal Impoverishment CSRA

The Community Spouse Resource Allowance determines how much of the couple's combined countable assets the at-home spouse may keep.

Calculating the CSRA. DoHS takes a snapshot of the couple's total countable assets on the snapshot date. The community spouse keeps half of that amount, subject to a federal floor and ceiling. West Virginia applies the full federal range, and it elects the federal maximum, so the protected share is never less than $32,532 and never more than $162,660 in 2026.1

• Minimum CSRA ($32,532). Even if half the couple's assets falls below this figure, the at-home spouse keeps at least $32,532.1
• Maximum CSRA ($162,660). Even if half the couple's assets exceeds this amount, the protected share is capped here.1

In practice: a couple with $120,000 in countable assets leaves the community spouse $60,000 (half). A couple with $40,000 leaves the community spouse the full $40,000, because the minimum applies. A couple with $400,000 leaves the community spouse $162,660, because the maximum caps the share.1

Countable vs. exempt assets. Not everything the couple owns counts toward the snapshot. Both spouses' assets are pooled regardless of whose name is on the account. Assets that are exempt include:

• The primary home, as long as the community spouse lives there (subject to the home-equity limit below)
• One vehicle used for transportation
• Household goods and personal belongings
• Prepaid irrevocable burial contracts and burial plots

Most financial accounts (checking and savings, CDs and money-market funds, stocks, bonds, and mutual funds), as well as second properties and both spouses' retirement accounts, count as countable assets.

The institutionalized spouse's share. After the community spouse's CSRA is set aside, the applicant must spend their remaining countable assets down to West Virginia's $2,000 individual resource limit before Medicaid will pay for care.1

Income Protections: The MMMNA

The MMMNA is the income counterpart to the CSRA. It sets the minimum monthly income the at-home spouse is entitled to keep, so the couple's income is not entirely consumed by the cost of the institutionalized spouse's care.

How the MMMNA range works. The federal MMMNA floor is $2,705.00 per month (effective July 1, 2026 through June 30, 2027; the floor resets each July). The ceiling is $4,066.50 per month, effective January 1, 2026. West Virginia follows these federal figures directly.1

The name-on-the-check rule. Under federal law, the community spouse keeps all of their own income regardless of amount, and income in the community spouse's name does not count against the applicant's Medicaid eligibility. Only the institutionalized spouse's income flows toward the cost of care. If the community spouse's own income already meets or exceeds the floor from Social Security, a pension, or investments, no income is diverted. If it falls short, the community spouse receives a monthly allocation from the institutionalized spouse's income to bring them up to the MMMNA.1

The excess-shelter adjustment. A community spouse whose shelter costs are high can qualify for an MMMNA above the floor. When the at-home spouse's shelter costs (rent or mortgage principal and interest, property taxes, homeowner's insurance, and a utility allowance) exceed a federal shelter standard, the excess is added to the base allowance, raising the MMMNA up to the $4,066.50 ceiling. Because the shelter standard is a federal figure that resets periodically, confirm the current amount with the Bureau for Medical Services before relying on a specific number.1

How the diversion works in practice. The institutionalized spouse's income is reduced by the Personal Needs Allowance ($50 per month in West Virginia), any Medicare Part B premium, and other allowed deductions. From the remainder, enough is diverted to the community spouse to reach the MMMNA. The net amount left over is the patient liability, paid to the nursing facility, and West Virginia Medicaid covers the balance of the cost of care.1

West Virginia's Spend-Down Model: No Miller Trust Required

West Virginia operates a medically needy spend-down program rather than a strict income cap. An applicant qualifies for long-term-care Medicaid one of two ways. First, under the gross income test, an applicant whose monthly income is at or below 300% of the maximum SSI payment ($2,982 per month in 2026) is income-eligible with no spend-down. Second, an applicant over that limit can still qualify through the medically needy program by spending excess income down on incurred medical and care costs each month. Because of the spend-down pathway, no Qualified Income Trust (Miller Trust) is required. That is simpler than in income-cap states, where a trust must be established and maintained before Medicaid will pay.1

The medically needy income level in West Virginia is a low fixed figure: $200 per month for one person, $275 for a couple. Most nursing-home applicants have income above that, so they qualify either under the 300%-of-SSI test or through the spend-down. For more on how income is counted, see West Virginia Medicaid eligibility and income limits.1

Home Equity and Estate Recovery

The primary home is generally exempt while the community spouse lives in it. West Virginia applies the federal-minimum home-equity limit of $752,000 for 2026, but that cap does not apply at all while a community spouse or dependent child lives in the home, so the home is fully protected during the community spouse's lifetime.2

After the institutionalized spouse passes away, West Virginia estate recovery may seek reimbursement for the cost of care from the deceased recipient's estate. Federal law bars any recovery while the community spouse is alive, while a child under 21 lives, or while a blind or permanently disabled child lives, and no recovery runs against the community spouse's own estate. West Virginia does not recover from estates valued at $5,000 or less. For how the state defines the recoverable estate and its hardship waivers, see our West Virginia Medicaid estate recovery guide.3

The Look-Back Period

Federal law applies a 60-month (five-year) look-back to uncompensated asset transfers when determining long-term-care eligibility. West Virginia applies the same 60-month window. Gifts or below-market transfers within five years of the application date can trigger a penalty period during which Medicaid will not pay for care. Transfers between spouses are exempt, so assets can be retitled into the community spouse's name without penalty, but the snapshot-date valuation still counts all couple assets regardless of titling.1

Medicaid Planning Strategies to Consider

West Virginia's federal-maximum CSRA and its no-Miller-Trust model give families a solid baseline. Where additional planning may help:

• Converting countable assets to exempt ones: home improvements, prepaying an irrevocable burial contract, or replacing an old vehicle.1
• Community-spouse annuities: converting excess countable assets into an income stream using an irrevocable annuity that meets Deficit Reduction Act of 2005 requirements.
• Requesting a fair hearing: if the standard CSRA cannot generate enough income to reach the MMMNA, a fair hearing may increase the resource allowance.

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

How to Apply for West Virginia Medicaid Long-Term Care

The CSRA and MMMNA are calculated as part of the nursing-home Medicaid application, which is handled by the DoHS Bureau for Medical Services. For a full walkthrough, see the West Virginia Medicaid how-to-apply guide.

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.