Community Spouse Resource Allowance Nebraska: 2026 Spousal Protections

When one spouse enters a nursing home or qualifies for Nebraska's AD Waiver, the healthy spouse left living at home — the "community spouse" — doesn't have to drain their savings to zero. Federal and state spousal impoverishment rules ensure the community spouse retains enough assets and income to maintain a basic standard of living.

Understanding these protections is essential because the calculations are precise, and families who don't know the rules often spend down more than required.

How the CSRA Works

At the point one spouse is institutionalized (or applies for waiver services), DHHS takes a snapshot of the couple's combined countable assets using the Designation of Resources form (Form MLTC/IM-73). The community spouse is then entitled to keep a portion of those joint assets, known as the Community Spouse Resource Allowance.

2026 CSRA limits:

• Minimum: $32,532 — if the couple's total countable assets are $65,064 or less, the community spouse keeps everything
• Maximum: $162,660 — if the couple's assets exceed $325,320, the community spouse keeps $162,660
• In between: the community spouse keeps exactly 50% of the couple's combined countable assets

The applying spouse must spend down their remaining share to $4,000 or below to qualify for Medicaid.

What counts as a countable asset: bank accounts, IRAs (Nebraska counts them), CDs, stocks, bonds, secondary real estate, secondary vehicles.

What's exempt: the primary residence (equity limit $752,000 — and fully exempt if the community spouse lives there), one vehicle, personal belongings, household furnishings, irrevocable burial trusts up to $6,696 per spouse.

Income Protections: The MMMNA

Beyond asset protection, Nebraska ensures the community spouse has sufficient monthly income through the Minimum Monthly Maintenance Needs Allowance (MMMNA).

Effective July 1, 2026: the MMMNA is $2,705/month. If the community spouse's own monthly income falls below this threshold, a portion of the institutionalized spouse's income is diverted to them as a Monthly Income Allowance, up to a maximum cap of $4,067/month.

The income diversion reduces the institutionalized spouse's share of cost — the amount they must pay toward their facility bill before Medicaid covers the rest.

The Shelter Standard Boost

The community spouse can further increase their income allowance if their housing costs exceed the shelter standard of $812/month (effective July 1, 2026 through June 30, 2027). Housing costs for this calculation include rent or mortgage payments, property taxes, homeowner's insurance, and a standard utility allowance.

If the community spouse's housing costs total $1,200/month, the amount above the $812 shelter standard ($388) is added to their MMMNA, boosting their protected income from $2,705 to $3,093/month (up to the $4,067 maximum).

Spend-Down Mechanics for Married Couples

Nebraska operates as a medically needy spend-down state, which works in the community spouse's favor. There's no hard income cap for the institutionalized spouse — they qualify through a spend-down process rather than being disqualified outright for earning too much.

The institutionalized spouse's share of cost calculation:

1. Start with total monthly income
2. Subtract the $75 personal needs allowance
3. Subtract any health insurance premiums
4. Subtract any Monthly Income Allowance diverted to the community spouse
5. The remaining amount goes to the facility as the share of cost
6. Medicaid pays the difference between the share of cost and the facility's actual charges

The Designation of Resources Form

The Form MLTC/IM-73 (Designation of Resources) is the formal document that splits the couple's assets at the point of institutionalization. This form is critically important — the snapshot date determines which assets are counted, and how they're categorized can determine how much the community spouse retains.

Common mistakes:

• Failing to file the form promptly — delays can result in assets being counted at a later (potentially less favorable) date
• Not realizing IRAs count — many families assume retirement accounts are exempt; in Nebraska, they are not
• Gifting assets before the snapshot — any transfer within the five-year look-back period creates a penalty

Planning Strategies

File the Designation of Resources immediately when one spouse enters a facility or applies for waiver services — don't wait for the full Medicaid application to process.

Convert countable assets to exempt ones before applying: prepaying funeral expenses into an irrevocable burial trust (up to $6,696 per spouse), paying down the mortgage on the primary residence, or making necessary home modifications.

Request a fair hearing if the calculated CSRA doesn't adequately support the community spouse. Nebraska allows appeals when the standard allowance leaves the community spouse in financial hardship.

The Nebraska Care Decision Guide includes the complete spousal protection worksheet, asset inventory calculator, and income diversion planning tools for married couples navigating the Medicaid application.

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