The majority of the questions that we receive pertain to several numbers found throughout the Health and Human Services Commission's Medicaid Eligibility Handbook.  For other information, call or Email your Medicaid Planning Questions

Click here for more information about gifts/transfers.

Monthly Maintenance Needs Allowance: $2,610.00

Applies when: One spouse lives in the nursing home and the other lives outside a nursing home

Definition: Minimum income each month that the spouse at home may keep. If both spouses combined income is lower than this amount, then the spouse at home keeps all of the income (and it may be possible to expand the resource allowance so the spouse at home can keep more than $104,400.00 of the total assets).

Minimum Community Spouse Resource Allowance: $20,880.00

Applies when: One spouse lives in the nursing home and the other lives outside a nursing home

Definition: Minimum amount of assets that a spouse at home may keep. If a couple's combined total assets are below this amount, then the spouse at home keeps all of the assets.

Maximum Community Spouse Resource Allowance: $104,400.00

Applies when: One spouse lives in the nursing home and the other lives outside a nursing home

Definition: Maximum amount of assets that the spouse at home may keep in most situations. The spouse at home may keep ½ of the total assets or $104,400.00, whichever is less. This can be higher using a formula from the state if the couple's combined income is less than $2,610.00 per month.

Monthly Personal Needs Allowance: $60.00

Applies when: A person is receiving Medicaid benefits in the nursing home

Definition: Monthly amount that a Medicaid recipient may keep for personal items which Medicaid does not cover (haircuts, snacks, etc.). An additional amount may be available for veterans.

Diversion Penalty Divisor: $122.50

Applies when: A potential Medicaid recipient transfers assets

Definition: This figure, based on the statewide average of daily nursing home costs, is used to determine the length of time an individual or couple is ineligible for Medicaid benefits because of transfers they have made.
(NOTE: A penalty is not assessed by the state in a month when the total amount of transfers, or gifts, total less than $200.00 for that month)

Income Cap State : $1,911.00

Applies when: A person in the nursing home applies for Medicaid benefits

Definition: Monthly income figure that determines income eligibility for Medicaid benefits. If an individual's income is less than this amount, then they are qualified in this area. If an individual's income is greater than this amount, then they have excess income and are ineligible for benefits. However, the state allows a Miller Trust or Qualifying Income Trust to be used to reduce their income on paper and qualify that person for benefits.

Resource Allowance for an Individual: $2,000.00

Applies when: A single person living in the nursing home applies for Medicaid benefits

Definition: Maximum amount of assets a single person may own and still qualify for Medicaid benefits.

Resource Allowance for a Couple:
(Both Husband and Wife in a Nursing Home) $3,000.00

Applies when: Both spouses reside in a nursing home

Definition: Maximum amount of assets a couple may own and still qualify for Medicaid benefits. If one spouse has received benefits for more than one year and then the other spouse moves to a nursing home and makes application, then a different rule may apply.

Call or email to discuss your family's situation...
In Texas 800-259-9674
Dallas / Fort Worth area 800-671-9181
Email your Medicaid Planning Questions