When working with a married couple wherein one spouse is applying for Medicaid and the other spouse resides at home, we typically refer to the Medicaid applicant as the institutionalized spouse and the spouse residing at home as the community spouse.
In 1988, Congress enacted Spousal Impoverishment provisions to prevent the community spouse who is still living at home in the community from becoming impoverished/with little or no income or resources. Under the Medicaid Spousal Impoverishment Provisions, a certain amount of the couple's combined resources is protected for the spouse living in the community. The Community Spouse Resource Allowance (CSRA) is the amount of countable resources a community spouse is allowed to keep when the institutionalized spouse applies for Medicaid. Please note that protected/exempt assets that the couple owns is not included in these resources. For example, since the home, car, personal property, prepaid funeral policies, etc. are all protected assets, these accounts will not be included in the CSRA.
In order to determine how many resources a community spouse can keep; we first need to establish if you reside in state that applies one standard amount for the CS to keep or if you reside in a state that has a minimum and maximum. State Medicaid agencies determine the CSRA one of two ways, as outlined below:
Some states apply one standard amount – the maximum.
Some states apply a minimum and maximum amount: generally, between $25,728 - $128,640. The couple’s total countable assets as of the “snap-shot date” are divided by 2, while staying within the minimum and maximum.
The States in orange apply one standard CSRA whereas the States in blue apply a minimum & maximum CSRA.
Let’s consider an example of a married couple, Robert and Nancy.
Maximum State
Robert is about to enter a nursing home and Nancy will remain at home. Robert and Nancy have total countable resources of $200,000. Using Robert and Nancy’s assets, let’s calculate the CSRA in a state where the maximum CSRA is allowed. The maximum CSRA is currently $128,640. Therefore, Nancy would be able to keep $128,640 of the $200,000. Robert as the institutionalized spouse would be able to keep approximately $2,000, in most states. We refer to this number as the institutionalized resource allowance (ISRA). Therefore, the total protected resources will equal $130,640. Robert and Nancy would need to spend-down $69,360 in order for Robert to be deemed resource eligible for Medicaid. We arrived at that number by taking their total countable resources of $200,000 and subtracting $2,000 for Nancy’s ISRA and $128,640 for Robert’s CSRA. Therefore, the couple has excess resources of $69,360.
Minimum & Maximum State
Alternatively, what if Robert and Nancy lived in a state where the total assets were divided in half, then the CSRA was set? As published on our website, the 2020 CSRA figures are as follows: Minimum $25,742 and Maximum is $128,640. Therefore, we’ll take their total assets ($200,000) and divide by 2 = $100,000. The CSRA becomes $100,000 and the CS must spend down $98,000 before Robert can qualify for Medicaid. We arrived at that number by taking their total countable resources of $200,000 and subtracting $2,000 for Nancy’s ISRA and $100,000 for Robert’s CSRA. Therefore, the couple has excess resources of $98,000.
What if the couple’s resources were $300,000 (instead of $200,000). In a minimum & maximum state, the total resources of $300,000 would be divided by 2 and we determine that half of the resources are $150,000. Since ½ of the resources is more than the maximum of $128,640, Robert’s CSRA would be capped at $128,640. Therefore, the couple has excess resources of $169,360. We arrived at that number by taking their total countable resources of $300,000 and subtracting $2,000 for Nancy’s ISRA and $128,640 for Robert’s CSRA. Therefore, the couple has excess resources of $169,360.
We created the following table to help you determine the CSRA in states that use a minimum and maximum CSRA:
