Texas Medicaid Spousal Allowance 2026: MMNA, CSRA, and Personal Needs Allowance

When one spouse enters a nursing home on Medicaid in Texas, the other spouse — the "community spouse" — does not have to become destitute. Federal and state law provide financial protections that let the at-home spouse retain income and assets above the Medicaid applicant's strict limits.

But these protections have specific dollar thresholds that change annually, and missing them means either leaving money on the table or jeopardizing the Medicaid application.

The Personal Needs Allowance (PNA)

The nursing home resident retains $75 per month from their own income for personal expenses — toiletries, clothing, phone calls, small purchases. This amount is set by Texas and is not adjusted annually by any formula.

Everything else from the resident's income goes toward the nursing home as their "patient liability" co-pay, after deducting the spousal allowance (see below) and any approved medical expenses.

The Monthly Maintenance Needs Allowance (MMNA)

The MMNA is the amount of the nursing home resident's income that can be redirected to the community spouse each month to ensure they can maintain a minimum standard of living.

2026 Texas MMNA thresholds:

• Minimum MMNA: $2,705/month (effective July 1, 2026)
• Maximum MMNA: $4,066.50/month (effective January 1, 2026)

Here is how it works: If the community spouse's own income (Social Security, pension, investment income) falls below $2,705 per month, the nursing home resident's income is redirected to bring the community spouse up to that minimum. The diversion can go as high as $4,066.50 per month if the community spouse can demonstrate higher shelter and utility costs.

Example: The community spouse receives $1,800/month from Social Security. The minimum MMNA is $2,705. The difference — $905 — is diverted from the nursing home resident's income to the community spouse each month, before the remaining income goes to the facility.

If the community spouse's own income already exceeds $4,066.50/month, no income diversion is permitted.

The Community Spouse Resource Allowance (CSRA)

The CSRA protects the community spouse's assets — the savings, investments, and property they are allowed to keep without jeopardizing the nursing home spouse's Medicaid eligibility.

2026 Texas CSRA thresholds:

• Minimum CSRA: $32,532
• Maximum CSRA: $162,660

When the nursing home spouse applies for Medicaid, HHSC conducts a "snapshot" assessment of the couple's combined countable assets on the date of the applicant's first continuous institutionalization. The community spouse can retain up to half of the couple's combined assets, but no less than $32,532 and no more than $162,660.

Example: A couple has $200,000 in combined countable assets. Half is $100,000, which falls between the minimum and maximum. The community spouse keeps $100,000. The nursing home spouse must spend down their remaining share to $2,000 before Medicaid will begin paying.

Example 2: A couple has $50,000 in combined assets. Half is $25,000, which is below the $32,532 minimum. The community spouse keeps the minimum $32,532. The nursing home spouse's countable share is $17,468, which must be spent down to $2,000.

The Homestead

The primary residence is exempt from the asset count as long as the community spouse (or a minor or disabled child) lives there. There is no equity limit when a community spouse resides in the home.

If the nursing home spouse is single — no community spouse — the home is exempt up to $752,000 in equity, provided the applicant declares an intent to return home. But after death, MERP can seek recovery from the probate estate, including the home.

How Income and Asset Calculations Interact

The Miller Trust, MMNA, PNA, and patient liability all work together in a specific order each month:

1. All of the nursing home resident's gross income is deposited into the Qualified Income Trust (Miller Trust) bank account
2. $75 is distributed to the resident as their Personal Needs Allowance
3. The approved MMNA amount is distributed to the community spouse
4. Any approved medical expenses (Medicare premiums, uncovered prescriptions) are deducted
5. The remaining balance is paid to the nursing home as patient liability

If any step is missed or the wrong amount is distributed in any given month, Medicaid eligibility for that month can be revoked and the facility bills at the private-pay rate.

What to Do

If your parent and their spouse are approaching a nursing home transition, calculate these numbers before submitting the Medicaid application. The CSRA snapshot date is especially critical — once it is set, it determines the community spouse's asset protection for the entire nursing home stay.

The Hospital-to-Home Texas toolkit includes a monthly income distribution worksheet for Miller Trust management and a CSRA calculation guide — designed for families handling this without a Certified Medicaid Planner.

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