How Medicaid’s Minimum Monthly Maintenance Needs Allowance Works & 2021 Limits

Last updated: July 11, 2021


What is the Minimum Monthly Maintenance Needs Allowance?

When applying for long-term care Medicaid, be that in a nursing home or for Home and Community Based Services (HCBS) in one’s home, an adult foster care home, or an assisted living residence via a Medicaid Waiver, there are income and asset limits that must be met. For married couples, with just one spouse applying for these types of benefits, there are spousal impoverishment rules in place to ensure the non-applicant spouse, often called the community spouse or well spouse, has sufficient financial means from which to live. To be very clear, spousal impoverishment rules do not apply when one spouse of a married couple is applying for a state’s regular Medicaid program. For the elderly, this program is often called Aged, Blind and Disabled Medicaid.

One spousal impoverishment rule is the Minimum Monthly Maintenance Needs Allowance (MMMNA). It allows a married Medicaid nursing home applicant or married HCBS Medicaid Waiver applicant to transfer a portion, or in some cases, all of his / her monthly income, to his / her non-applicant spouse. The MMMNA is intended for non-applicant spouses who have little to no monthly income. Medicaid’s income limit is fairly restrictive, so this rule is in place to ensure the non-applicant spouse is left with sufficient income. In order to receive this spousal allowance, the community spouse’s monthly income must fall under a certain level.

When it comes to spousal impoverishment provisions, an applicant spouse is often referred to as the institutionalized spouse. This can be a bit confusing since the applicant spouse does not have to be institutionalized (reside in a nursing home). Rather, the applicant spouse can receive long-term care services in his / her home or community via a HCBS Medicaid Waiver.

It should be mentioned that there is also a Community Spouse Resource Allowance (CSRA), which protects a certain amount of the couple’s resources for the community spouse. Only the MMMNA will be covered in this article, but one can learn more about the CSRA here.

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Min. and Max. MMMNA Figures for 2021

As of July 1, 2021, the MMMNA is $2,177.50 / month in 48 states and in the District of Columbia. Some states round this figure to $2,178.00 / month. Due to the higher cost of living, Hawaii has a MMMNA of $2,505.00 / month, and Alaska has a MMMNA of $2,721.25 / month. These figures, which change annually in July, are set by the federal government, and are based on the Federal Poverty Level.

If the non-applicant spouse’s income falls under the above minimum amount for one’s state, the applicant spouse can transfer his/her income to his/her spouse, bringing the non-applicant spouse’s income to the minimum level. For instance, a non-applicant spouse in Pennsylvania who has a monthly income of $1,600 is able to receive $577.50 / month from the applicant spouse, increasing his/her income to the MMMNA of $2,177.50 / month.

The maximum community spouse income maintenance allowance is $3,259.50 / month, effective January 2021 – December 2021. Some states round up to $3,260 / month. This figure is calculated based on the SSI Federal Benefit Rate (FBR) and increases each January.

Not all states utilize a minimum and maximum income allowance. Some states use just one figure that falls somewhere between the federally set minimum and maximum figures. For example, as of 2021, New York, Texas, and California all use a standard monthly figure of $3,259.50, and Illinois uses a standard monthly figure of $2,739.

 The income transferred from an institutionalized spouse (a spouse in a Medicaid-funded nursing home or receiving home and community based services via a Medicaid waiver) to a community spouse does not count against Medicaid eligibility. More on how Medicaid counts income.  


Is it Possible to Transfer More Monthly Income?

In simple terms, yes, it is possible for a Medicaid applicant spouse to transfer monthly income greater than the MMMNA to his / her non-applicant spouse. As mentioned previously, the federal government also sets a maximum community spouse income maintenance allowance, which as of January 2021, is $3,259.50 / month.

To receive income greater than the minimum needs allowance, the non-applicant’s “shelter” costs are taken into account. This includes expenses such as rent, mortgage, property taxes, homeowners insurance, and utilities. If one’s “shelter” costs are high relative to the MMMNA, the community spouse might be entitled to a higher level of income from the applicant spouse.

Please note: If a state does not use both a minimum and maximum needs allowance, there is no need to take shelter and utility costs into account. Rather, the non-applicant spouse is automatically entitled to income from the applicant spouse to bring his/her income level to the state’s monthly maintenance needs allowance figure.

Monthly Housing Allowance

The Community Spouse Monthly Housing Allowance, also referred to as a Shelter Allowance or Excess Shelter Allowance, includes expenses such as rent, mortgage, property taxes, and homeowners’ insurance. Based on the community spouse’s shelter costs and the MMMNA in the state in which he/she resides, he/she might be entitled to a higher spousal allowance.

As of July 1, 2021, the shelter allowance is $653.25 / month for 48 of the 50 states, as well as the District of Columbia. Some states round this figure to $654 / month. In Alaska, the shelter allowance is set at $816.38 / month, and it is $751.50 / month in Hawaii. These figures are calculated each July and are based on a percentage of the minimum monthly maintenance needs allowance. Very generalized, it is assumed that a community spouse has sufficient funds in which to pay his/her shelter expenses if his/her income is equivalent to the MMMNA and his/her shelter costs do not exceed the monthly housing allowance. If the shelter costs are greater than the set monthly housing allowance, the community spouse is entitled to a greater MMMNA. For instance, if one’s shelter costs are $150 / month over the shelter allowance, one’s MMMNA will be increased by $150 / month. However, the maximum monthly income to which a community spouse is entitled, regardless of shelter costs, is the maximum monthly maintenance needs allowance of $3,259.50.

Standard Utility Allowance

A Standard Utility Allowance (SUA) is also taken into account when determining one’s MMMNA. This is the average utility cost, which may include cooling/heating, electricity, basic phone service, sewage, garbage, and water costs, in the state in which one resides. This figure is set by each state, so it varies based on the state in which one resides. This figure is added to the monthly housing allowance and can also increase the monthly maintenance needs allowance to which a community spouse is entitled. Please bear in mind, this figure also varies based on if one pays heating and cooling costs separately from their rent and what other utilities one pays.

MMMNA Calculation Example

John and Rose live in Florida. John has Alzheimer’s disease that has progressed to the stage that he requires 24-hour supervision. Therefore, he has relocated to a Medicaid funded nursing home. John has $2,600 / month in income, and Rose’s monthly income is $794. In Florida, the Minimum Monthly Maintenance Needs Allowance is set at $2,178 and the Maximum Monthly Maintenance Needs Allowance is $3,260. Since Rose’s income of $794 / month is under the MMMNA of $2,178, she is automatically entitled to $1,384 / month of John’s income to bring her income level up to the MMMNA of $2,178 / month.

In Florida, the Community Spouse Monthly Housing Allowance is set at $654 / month and the Standard Utility Allowance (SUA) is $370 / month.

Rose has a mortgage and real estate tax payment of $1,425 / month and a homeowners insurance payment of $100 / month, for a total of $1,525 / month. Rose pays for heating and cooling of her home, so a SUA of $370 / month is added to her monthly shelter costs. ($1,525 + $370 = $1,895 / month in total shelter costs). Since her total monthly shelter cost is over the standard monthly housing allowance of $654, this figure is deducted from Rose’s monthly shelter costs. ($1,895 / month – $654 / month = $1,241 / month in which Rose is entitled in shelter costs).

As mentioned above, Rose is entitled to $1,384 / month to bring her income level up to the MMMNA of $2,178 and she is entitled to $1,241 / month in excess shelter costs. This brings the total to $2,625 / month to which Rose might be entitled. ($1,384 + $1,241 = $2,625)

However, with Rose’s own income ($794 / month) and the income to which she might be entitled to from her institutionalized spouse ($1,384 to reach the MMMNA and $1,241 in excess shelter costs = $2,625), her total monthly income would come to $3,419 / month. Since this figure is over the maximum monthly maintenance needs allowance of $3,260 / month in Florida, she is entitled only to $2,466 / month from her institutionalized spouse, bringing her total income to $3,260 / month.  


Help Determining MMMNA & Qualifying for Medicaid

When only one spouse of a married couple applies for nursing home Medicaid or a HCBS Medicaid Waiver, it can be a complicated process. It is highly advised one seek the counsel of a Medicaid expert in this situation. Professional Medicaid planners can offer assistance in maximizing the amount of income a non-applicant spouse receives. Furthermore, they can help the non-applicant spouse preserve a greater amount of the couple’s joint assets while easing the application process and increasing the likelihood the applicant spouse will qualify for Medicaid. Locate a Medicaid planner here.

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