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. For 2026, the federal resource standards behind the at-home (community) spouse's share are a $32,532 minimum and a $162,660 maximum, and the monthly income floor is $2,705.00.1 West Virginia Medicaid also says some applicants whose income is above the maximum allowed level may still become eligible through spenddown.2

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.4

West Virginia Medicaid is administered by the West Virginia Department of Human Services (DoHS) Bureau for Medical Services.2 The two federal protections are the Community Spouse Resource Allowance (CSRA) on assets and the community spouse monthly income allowance, built on 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.4

The Snapshot Date

Every spousal impoverishment calculation starts from the snapshot date: the beginning of the institutionalized spouse's first continuous period of institutionalization.4

The snapshot date matters because the spousal share is computed from the total value of everything either spouse owned an interest in on 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. At either spouse's request, the state must assess and document that total at the start of the stay and give each spouse a copy with notice of the right to a fair hearing. Preserve bank, brokerage, and asset statements dated on or near the snapshot date, because DoHS uses them to set the CSRA.4

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 (the spousal share), measured against two federal resource standards that CMS set for 2026: a $32,532 minimum and a $162,660 maximum.1,4

• Minimum standard ($32,532). Even if half the couple's assets falls below this figure, the at-home spouse keeps at least $32,532. A state may set a higher minimum, up to the federal maximum.1
• Maximum standard ($162,660). When half the couple's assets exceeds this amount, the standard calculation stops here.1

The $162,660 figure is not an absolute cap on what the community spouse can keep. Federal law also protects an amount set at a fair hearing, when the standard allowance cannot produce enough income to bring the community spouse up to the MMMNA, and an amount transferred under a court order. Either can exceed $162,660.1

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 under the standard calculation, unless a fair hearing or court order sets a higher amount.1

Countable vs. excluded assets. Both spouses' resources are pooled regardless of whose name is on the account, and regardless of any state community-property or marital-property law.4 Some assets are excluded from the count. The home matters most for married couples: while the community spouse lives there, the federal home-equity limit does not apply at all (see below).3 West Virginia sets its own list of other excluded assets, so ask your DoHS county worker which of your accounts and belongings count before you rely on an exclusion.2

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.2

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 in every state except Alaska and Hawaii, effective July 1, 2026 through June 30, 2027. The ceiling is $4,066.50 per month, effective January 1, 2026.1 Federal law lets each state set its MMMNA at or above the floor, subject to that ceiling.4

The name-on-the-check rule. Under federal law, while the institutionalized spouse is in the institution, no income of the community spouse is deemed available to the institutionalized spouse, and income paid solely in the community spouse's name is treated as that spouse's alone.1 If the community spouse's own income from Social Security, a pension, or investments already meets or exceeds the MMMNA, no income allowance is owed. If it falls short, the community spouse receives a monthly allowance from the institutionalized spouse's income equal to the gap, to the extent that income is actually made available to them.4

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, taxes, insurance, any condominium or co-op maintenance charge, plus the state's standard utility allowance) exceed the federal excess-shelter standard of $811.50 per month (effective July 1, 2026), the excess is added to the floor, raising the MMMNA up to the $4,066.50 ceiling.1,4 If either spouse shows at a fair hearing that the community spouse needs more because of exceptional circumstances resulting in significant financial duress, the hearing can substitute an amount adequate to provide that additional income.1

How the diversion works in practice. After the institutionalized spouse is found eligible, the community spouse's income allowance is deducted from the institutionalized spouse's monthly income after the Personal Needs Allowance.4 Federal law sets that allowance at no less than $30 a month and lets each state set it higher, and the state also deducts incurred medical expenses that no third party pays, including health-insurance premiums.5 Ask your DoHS worker for West Virginia's current Personal Needs Allowance and how the rest of the income will be applied to the cost of care.

When the Applicant's Income Is Over the Limit: Spenddown

The spousal rules protect the community spouse; the institutionalized spouse still has to meet West Virginia's own income test. The Bureau for Medical Services says some people who are ineligible when they apply, because their income is higher than the maximum allowed level, may become eligible under "spenddown," and that the local DoHS worker will explain the process if it applies.2

For reference, CMS's 2026 figures put the SSI federal benefit rate at $994 a month and the 300% income cap at $2,982 a month. Ask your DoHS worker how West Virginia applies that figure to a nursing-facility or waiver application before you pay for any income-planning device. For more on how income is counted, see West Virginia Medicaid eligibility and income limits.2

Home Equity and Estate Recovery

The federal home-equity limit for 2026 is $752,000 unless the state elects a higher amount, up to $1,130,000. That limit does not apply at all while the applicant's spouse, a child under 21, or a blind or permanently and totally disabled child lawfully lives in the home, so home equity of any amount does not by itself disqualify the applicant while the community spouse lives there.3

After the institutionalized spouse passes away, West Virginia estate recovery may seek reimbursement for the cost of care from the deceased recipient's estate. Under the Bureau for Medical Services' estate-recovery manual, recovery waits until after the death of the member's spouse, and also until there is no surviving child under 21, no blind or permanently and totally disabled child still lawfully living in the home, and no sibling with an equity interest still lawfully living there. No lien may be placed on the home while it is the lawful residence of the spouse, a child under 21, a blind or permanently and totally disabled child, or a sibling with an equity interest who lived there for at least a year before the member entered a medical institution. West Virginia imposes no recovery on estates valued at $5,000 or less when the estate is admitted to probate. One caution: West Virginia does not confine recovery to the probate estate. The Bureau for Medical Services defines the recoverable estate by cross-reference to the state's estate-tax definition of property, which reaches further, so do not assume that jointly held or transfer-on-death property is automatically out of reach. For how the state defines the recoverable estate and its hardship waivers, see our West Virginia Medicaid estate recovery guide.6

The Look-Back Period

The Bureau for Medical Services says a period of ineligibility for Medicaid long-term care may result if resources, including certain trusts, were transferred within the 60 months before the date of application.2 Moving the CSRA to the community spouse is different: the institutionalized spouse may transfer an amount equal to the CSRA to the community spouse without a transfer penalty, and should do so as soon as practicable after the first eligibility decision. Retitling does not change the snapshot, which still counts everything either spouse owned on that date.4

Medicaid Planning Strategies to Consider

The standard CSRA and MMMNA protect a baseline. Where additional planning may help:

• Spending countable assets on excluded ones: West Virginia excludes some assets from the count; confirm with your DoHS worker that a purchase will be excluded before you make it.2
• Community-spouse annuities: converting excess countable assets into an income stream. Under the Deficit Reduction Act of 2005 rules, buying one is treated as a transfer for less than fair market value, which can bring a penalty, unless the state is named remainder beneficiary (first, or second after the community spouse or a minor or disabled child), and one bought outside a retirement account counts as an asset unless it is irrevocable, nonassignable, actuarially sound, and pays in equal amounts with no deferral or balloon payment.7
• Requesting a fair hearing: if the standard CSRA cannot generate enough income to reach the MMMNA, a fair hearing may raise the resource allowance. The state must first count all of the institutionalized spouse's income that could be made available to the community spouse (the "income first" rule), which narrows when this route adds anything.1

Couples with countable assets well above the $162,660 maximum standard should consult a West Virginia-licensed elder-law attorney before applying. For broader options, see Medicaid planning strategies.1

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.

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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.