Mississippi Medicaid Spousal Impoverishment — CSRA, MMNA, and Protecting the Healthy Spouse

The Fear: "Will Medicaid Take Everything We Own?"

When one spouse in a Mississippi marriage needs long-term care — whether in a nursing home or through the E&D Waiver at home — the other spouse's financial survival becomes an immediate concern. Federal and state spousal impoverishment protections exist specifically to prevent the healthy spouse from being wiped out by Medicaid's asset and income rules.

These protections are meaningful, but they have rigid limits that families need to understand before filing.

The Community Spouse Resource Allowance (CSRA)

When only one spouse applies for Medicaid long-term care, the couple's combined countable assets are evaluated, then divided. The applying spouse can keep only $4,000 in countable assets. The community spouse — the one staying at home — can retain up to $162,660 in 2026. This is the Community Spouse Resource Allowance.

All jointly held assets must be disclosed. A joint checking account, joint savings, investment accounts, CDs — everything countable goes into the calculation. The division protects up to $162,660 for the community spouse and caps the applicant at $4,000.

What counts as exempt (not subject to the limit):

• The primary residence, up to $752,000 in home equity
• One vehicle
• Household goods and personal effects
• Irrevocable burial contracts up to $1,500
• Life insurance with face value under $10,000

What counts against the limit:

• Checking and savings accounts (beyond the applicant's $4,000)
• Stocks, bonds, mutual funds, brokerage accounts
• CDs and money market accounts
• Real estate other than the primary home
• Life insurance policies with cash surrender value when face value exceeds $10,000

The Monthly Maintenance Needs Allowance (MMNA)

The community spouse's income matters too, but in the opposite direction. The MMNA protects the community spouse's ability to cover basic living expenses after the applicant's income is redirected toward care.

If the community spouse's own monthly income is below $4,066.50 (the 2026 MMNA cap), the applicant can transfer a portion of their income to bring the community spouse up to that level. This transferred amount is excluded from the applicant's income for Medicaid eligibility and cost-of-care calculations.

The practical effect: a community spouse with $1,500/month in Social Security income could receive up to $2,566.50 from the applicant spouse's income, without affecting Medicaid eligibility.

The community spouse's own separate income — their own Social Security, their own pension — is never counted toward the applicant's eligibility. Only the applicant's income is evaluated against the $2,982 cap.

How Asset Division Happens in Practice

Medicaid calculates the couple's total countable resources at the time of application (the "snapshot" date). Here's a simplified example:

• Combined countable assets: $200,000
• CSRA cap: $162,660
• Community spouse keeps: $162,660
• Applicant must spend down to: $4,000
• Excess to address: $200,000 – $162,660 – $4,000 = $33,340

That $33,340 gap must be spent on non-countable items before the applicant qualifies. Common spend-down strategies include prepaying funeral and burial expenses, paying off the mortgage on the primary home, making home modifications, purchasing a newer vehicle (if the existing one needs replacement), or paying outstanding medical bills.

Asset transfers between spouses are not subject to the 60-month look-back penalty. Moving assets from the applicant to the community spouse to reach the $4,000 threshold is expected and allowed — as long as the community spouse's total doesn't exceed the CSRA.

Where It Gets Complicated

Assets above $162,660. If the community spouse has more than the CSRA cap after the split, the excess must be spent down. A community spouse with $300,000 in individual retirement accounts faces a real planning challenge.

Income above $4,066.50. If the community spouse's income already exceeds the MMNA, no income transfer from the applicant is allowed. The applicant's full income goes toward their care contribution.

QIT interaction. If the applicant needs a Qualified Income Trust because their income exceeds $2,982, the spousal maintenance allowance is one of the authorized deductions from the trust before the excess flows to Medicaid.

Asset transfers that violate the look-back. Transferring assets to anyone other than the community spouse — such as adult children — within 60 months of the application triggers a transfer penalty. The spousal transfer exception only applies between spouses.

Our Mississippi Home Care Guide walks through the spousal impoverishment calculations with worksheets, spend-down strategies, and the QIT coordination steps married couples need to navigate.

See more Mississippi guides →