When working with clients who are facing an immediate care need, having fast access to accurate, state-specific Medicaid planning figures is critical. A reliable “cheat sheet” allows you to evaluate options quickly, avoid costly mistakes, and collaborate more effectively with attorneys and care teams. Just as important as knowing the numbers is understanding how and when each figure applies.
That’s where the Medicaid Desk Reference comes in.
What Is the Medicaid Desk Reference?
The Medicaid Desk Reference is a state-specific planning resource designed to help professionals assess eligibility rules and structure effective spend-down strategies with confidence. With one consolidated tool, you can quickly address questions such as:
- How much can my client retain in countable assets?
- Will prior gifts trigger a penalty period—and for how long?
- Is the community spouse eligible for an income shift?
Because Medicaid rules and figures can change multiple times per year—often in January, July, or October, and sometimes without notice—staying current is essential to protecting your clients and your recommendations.
Contracted agents can log in to our Agent Portal to download your state’s Medicaid Desk Reference and stay informed of updates.
Key Medicaid Planning Terms Every Planning Professional Should Know
Divestment Penalty Divisor
This state-specific figure is used to calculate an applicant’s penalty period and reflects the average private-pay cost of nursing home care. To calculate a Medicaid penalty period, the total amount of gifts made during the five-year lookback is divided by this divisor. The result determines how long the applicant must privately pay for care before Medicaid eligibility begins. States may use monthly rates, daily rates, or multiple divisors.
Individual Resource Allowance
This allowance determines how much a Medicaid applicant may retain in countable assets while still qualifying for benefits. In many states, this amount is limited to $2,000 and is intended for personal discretionary use.
Resource Allowance for a Couple
If both spouses are institutionalized, they do not each retain a full individual allowance. Instead, they share a combined resource allowance—often $3,000, though this varies by state.
Personal Needs Allowance
This allowance is the portion of the institutionalized individual’s income that may be retained each month for personal expenses, such as clothing or toiletries. This amount is excluded from the monthly co-pay to the facility but may be counted as an asset in future months if not spent.
Protecting the Community Spouse
Community Spouse Resource Allowance (CSRA)
The CSRA determines how much in countable assets the at-home spouse may retain when the other spouse applies for Medicaid.
- Standard CSRA states require excess assets above a fixed limit to be spent down.
- Minimum/maximum CSRA states allow the community spouse to retain one-half of the couple’s assets as of the snapshot date, subject to state-imposed minimums and maximums.
Monthly Maintenance Needs Allowance (MMNA)
The MMNA sets the minimum monthly income the community spouse is entitled to keep. If their income falls below this amount, they may receive an income shift from the institutionalized spouse.
- Standard MMNA states allow income shifts up to a fixed amount.
- Minimum/maximum MMNA states may allow higher income shifts when shelter expenses exceed state thresholds, subject to state-imposed minimums and maximums.
Shelter Standard & Standard Utility Allowance
These figures are used to calculate the community spouse’s housing costs. If actual shelter expenses exceed the shelter standard, the MMNA may be increased up to the state maximum. Many states use a standard utility allowance instead of actual bills to simplify calculations.
Read More: How MCAs Help Prevent Spousal Impoverishment When One Spouse Needs Care
Other Key Medicaid Figures to Watch
Funeral Expense Trust Limit
Irrevocable funeral trusts are typically exempt from Medicaid if they fall within state limits. Some states impose caps, while others do not. Many also require a Letter of Goods and Services to document value.
Life Insurance Limit
Life insurance policies with face values below the state threshold are often exempt from Medicaid. Policies exceeding the limit may be treated as countable resources.
Home Equity Limit
For unmarried applicants, states cap how much home equity may be retained while qualifying for Medicaid. Equity above this limit may become countable unless reduced through permitted planning strategies.
Strengthen Your Planning Conversations
Understanding these figures and how they impact your clients’ Medicaid eligibility allows you to better support clients, coordinate with elder law attorneys, and position appropriate planning solutions, especially in crisis scenarios.
For a deeper dive into how professionals can use the Medicaid Desk Reference in real-world planning scenarios, check out our recent webinar featuring Dale Krause.