Medicaid's CSRA: Protecting a Healthy Spouse from Poverty

Medicaid law provides special protections for the spouses of Medicaid applicants to make sure the spouses have the minimum support needed to continue to live in the community while their loved one is receiving long-term care benefits, usually in a nursing home.

One of the most important protections is the Community Spouse Resource Allowance (CSRA). It works this way: if the Medicaid applicant is married, the countable assets of both the community spouse and the institutionalized spouse are totaled as of the day the ill spouse enters either a hospital or a long-term care facility where they stay for at least 30 days. This is sometimes called the "snapshot" date because Medicaid is taking a picture of the couple's assets as of this date.

Medicaid Eligibility Requirments

In order to be eligible for Medicaid benefits, a nursing home resident may have no more than $2,000 in assets (the amount may be somewhat higher in some states). In general, the community spouse may keep half of the couple's total countable assets up to a maximum of $154,140 (in 2024). This is the community spouse resource allowance (CSRA), the most that a state may allow a community spouse to retain without a hearing or a court order. The least that a state may allow a community spouse to retain is $30,828 (in 2024).

Example: If a couple has $100,000 in countable assets on the date the applicant enters a nursing home, they will be eligible for Medicaid once the couple's assets have been reduced to a combined figure of $52,000 -- $2,000 for the applicant and $50,000 for the community spouse.

Check the Rules in Your State

Some states, however, are more generous toward the community spouse. In these states, the community spouse may keep up to $154,140 (in 2024), regardless of whether or not this represents half the couple's assets. For example, if the couple had $100,000 in countable assets on the "snapshot" date, the community spouse could keep the entire amount, instead of being limited to half.

See also Medicaid's MMMNA Ensures a Healthy Spouse Has Enough Income. If you or a spouse are transferring to long-term care in a nursing home now or in the near future, contact an elder law attorney near you to create a plan.