West Virginia Medicaid Spousal Impoverishment 2026: CSRA Guide

West Virginia Medicaid spousal impoverishment rules protect the at-home spouse when a partner enters nursing facility care. West Virginia uses a spend-down model.

How West Virginia Medicaid Spousal Impoverishment Works

When one spouse enters a nursing facility or qualifies for a home- and community-based services (HCBS) waiver, West Virginia Medicaid 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.

West Virginia Medicaid is administered by the Department of Human Services (DoHS) Bureau for Medical Services. West Virginia operates a medically needy spend-down program: an applicant whose income exceeds the income standard can qualify by spending down excess income on medical and care costs. No Miller Trust is required.

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 West Virginia 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 West Virginia Medicaid long-term care coverage.

The Snapshot Date

Before West Virginia 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 Medicaid application.

The Half-of-Assets Formula

West Virginia applies the federal formula: 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)

West Virginia applies the federal maximum, giving West Virginia 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 Charleston has $80,000 in joint savings and a $40,000 CD. Total: $120,000. Half is $60,000, which falls between the floor and ceiling, so the community spouse keeps $60,000.

The institutionalized spouse's share is $60,000. West Virginia allows a single applicant $2,000 in countable assets, so roughly $58,000 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 West Virginia Medicaid Spousal Impoverishment MMMNA Works

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

For 2026, West Virginia 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, West Virginia 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 ($50/month in West Virginia), 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. West Virginia 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 $1,100/month from Social Security. The MMMNA floor is $2,643.75/month. Her shortfall is $1,543.75/month. The institutionalized spouse receives $2,400/month from pension and Social Security. After the $50 PNA and a $185 Medicare Part B premium, $2,165 is available. Of that, $1,543.75 is diverted to the community spouse. The remaining $621.25 goes to the nursing facility. West Virginia Medicaid covers the rest.

The community spouse moves from $1,100/month to $2,643.75/month.

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.

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

West Virginia operates a medically needy spend-down program. The institutionalized spouse qualifies for Medicaid by incurring excess income on medical and care costs each month. No Qualified Income Trust (Miller Trust) is required.

The medically needy income limit in West Virginia is a low monthly figure (roughly $200/month for an individual). Most nursing home applicants will have income above that level and will qualify through the spend-down. This is simpler than in income-cap states, where a trust must be established and maintained before Medicaid will pay. For more on income eligibility, see West Virginia Medicaid eligibility and income limits.

The Home and Home Equity in West Virginia

The primary residence is exempt from Medicaid eligibility calculations as long as the community spouse lives there.

For 2026, the West Virginia home equity cap is $752,000. If the community spouse lives in the home, the equity cap rarely comes into play.

West Virginia applies a 60-month lookback on asset transfers. Consult an elder law attorney if any assets were transferred within five years before application.

Assets That Are Exempt

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

• Primary residence (equity up to $752,000 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

West Virginia Medicaid Spousal Impoverishment and the Application Process

Who Administers This

West Virginia Medicaid for long-term care is administered by the Department of Human Services (DoHS) Bureau for Medical Services. The CSRA and MMMNA are calculated as part of the nursing home Medicaid application.

How to Apply

Apply online through WV PATH or by phone at 1-877-716-1212. For a full walkthrough, see the West Virginia 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 at wvpath.wv.gov or by phone at 1-877-716-1212.
3. DoHS calculates the CSRA and MMMNA and notifies both spouses.
4. Both spouses have the right to appeal any determination.

Medicaid Planning Strategies to Consider

West Virginia's federal-maximum CSRA and its no-Miller-Trust model give families a solid baseline. 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 West Virginia-licensed elder law attorney before applying.

Learn More

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

Find personalized help understanding West Virginia 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.