📋 Your Situation
*California eliminated its asset limit in 2024 for most programs
Please select your state.
Married couples have higher asset protections (CSRA)
Savings, investments, non-exempt assets. Exclude home & car.
Enter a valid asset amount.
National median 2024: $8,929/mo. Enter your state’s rate.
Enter a valid monthly cost.
Social Security, pension, all income sources
Enter valid monthly income.
Gifts or sales below fair market value — may create penalty
Enter valid transfer amount.
Amount You Must Spend Down
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⚠️ Disclaimer: This calculator provides estimates based on general Medicaid rules and 2026 state limits. Medicaid rules are extremely complex and vary significantly by state, program type, individual circumstances, and change frequently. This is not legal advice. Always consult a certified elder law attorney (CELA) or certified Medicaid planner (CMP) before making any asset transfers or Medicaid planning decisions. Errors can result in penalty periods of ineligibility.
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Sources & Methodology
State asset limits verified against 2026 CMS Medicaid data and American Council on Aging state-by-state Medicaid eligibility charts. CSRA limits from 2026 CMS spousal impoverishment standards.
CMS Medicaid.gov — Long-Term Services & Supports
Official CMS guidance on Medicaid nursing facility eligibility, asset limits, spousal impoverishment protections (CSRA), and look-back period rules. Primary authority source for all federal Medicaid standards used in this calculator.
American Council on Aging — 2026 Medicaid Eligibility by State
Comprehensive state-by-state Medicaid asset and income limits, CSRA ranges, and income cap vs medically needy state classifications. Used to populate state-specific asset limit data in this calculator.
Nolo — Safe Ways to Spend Down Assets for Medicaid
Attorney-reviewed guide on allowable Medicaid spend-down expenditures, exempt asset categories, and look-back period rules. Used to develop the allowable spend-down item breakdown in this calculator.
Methodology: Single applicant spend-down = max(0, total countable assets minus state single limit). Married/one applicant: CSRA = min(max(29724, total assets x 0.50), 157920); applicant keeps state single limit; spend-down = max(0, total assets minus CSRA minus state single limit). Married/both: spend-down = max(0, total assets minus state couples limit). Months to eligibility: spend-down divided by (monthly cost minus monthly income). Penalty period: transfer amount divided by monthly nursing home cost. All figures are estimates only. State limits: standard $2,000 single / $3,000 couples unless otherwise specified.
Last reviewed: April 2026
How Medicaid Spend Down Works: The Complete 2026 Guide
To qualify for Medicaid long-term care (nursing home, assisted living through HCBS waiver, or home health care), you must have countable assets at or below your state's asset limit. In most states, that limit is $2,000 for a single individual. If you have more than that in countable assets, you must spend down — reduce those assets to the limit — before Medicaid begins paying for your care. This process is called a Medicaid spend down, and it is the primary financial gateway to accessing Medicaid-funded long-term care for the estimated 62% of nursing home residents who rely on Medicaid.
Spend-Down Amount = Total Countable Assets − State Asset Limit
Months to Eligibility = Spend-Down Amount ÷ (Monthly Care Cost − Monthly Income)
Example — Single, Florida, standard $2,000 limit:
Total countable assets: $80,000 • State limit: $2,000
Spend-down required: $80,000 − $2,000 = $78,000
Monthly nursing home cost: $9,000 • Monthly income: $2,200
Net monthly spend: $9,000 − $2,200 = $6,800
Months to eligibility: $78,000 ÷ $6,800 = ~11.5 months
Total countable assets: $80,000 • State limit: $2,000
Spend-down required: $80,000 − $2,000 = $78,000
Monthly nursing home cost: $9,000 • Monthly income: $2,200
Net monthly spend: $9,000 − $2,200 = $6,800
Months to eligibility: $78,000 ÷ $6,800 = ~11.5 months
Medicaid Asset Limits by State (2026)
| State | Single Applicant | Couple (Both Apply) | Notes |
|---|---|---|---|
| Most states (default) | $2,000 | $3,000 | Standard federal floor |
| California | No limit | No limit | Eliminated asset rule 2024 |
| New York | $33,038 | $33,038 | Higher individual limit |
| Illinois | $17,500 | $17,500 | Above average limit |
| Missouri | $6,069 | $6,069 | State-specific |
| Connecticut | $1,600 | $3,200 | Below standard limit |
| Arizona / DC | $4,000 | $6,000 | Above standard limit |
Community Spouse Resource Allowance (CSRA) — Protecting the At-Home Spouse
When only one spouse needs nursing home Medicaid, the healthy at-home spouse (community spouse) is protected from complete financial devastation through the Community Spouse Resource Allowance (CSRA). In 2026, the CSRA ranges from $29,724 to $157,920 depending on the state. Most states calculate the CSRA as 50% of the couple's combined countable assets at the time the ill spouse enters a care facility, up to the state maximum. The applicant spouse may keep only $2,000 (in most states), while the community spouse keeps the CSRA.
What Assets Are Exempt from Medicaid Spend Down?
- Primary home: Exempt if the applicant or spouse lives there, or there is intent to return. Home equity limit: approximately $730,000 in most states (2026).
- One automobile: One vehicle of any value is typically exempt regardless of value in most states.
- Personal property: Household goods, furniture, clothing, and personal effects.
- Prepaid funeral/burial: Irrevocable prepaid funeral contracts and burial spaces (limits vary by state).
- Small life insurance: Term life insurance (no cash value) is exempt; whole life with cash value under ~$1,500 face value may be exempt in some states.
- Wedding and engagement rings: Exempt in all states.
- Business assets: Assets essential to self-employment that generate income may be exempt.
Allowable Medicaid Spend-Down Items (What You Can Spend On)
You can spend down on virtually anything for your own or your spouse's benefit, including: nursing home or home health care costs, medical equipment, home modifications for accessibility (ramps, grab bars, stair lifts), prepaying the mortgage or paying off debts, dental and vision care, prepaying funeral expenses, updating or replacing a car, legal fees for Medicaid planning, and replacing or repairing household goods. You cannot give money to family members or friends (this triggers look-back penalties) and generally cannot spend on gifts or luxury items.
💡 The 5-Year Look-Back Warning: Any assets transferred for less than fair market value within 60 months before your Medicaid application will be reviewed. Gifts to children, sales of property below market value, and transfers to trusts within 5 years can all create penalty periods. Each $8,929 (national average monthly NH cost) of improper transfers creates approximately one month of penalty. A $100,000 gift creates an approximately 11-month period during which Medicaid will not pay for care. Consult a certified elder law attorney BEFORE making any transfers.
Safe Medicaid Planning Strategies (With an Elder Law Attorney)
- Medicaid Asset Protection Trust (MAPT): An irrevocable trust that removes assets from countable status after 5 years. Must be created well before care is needed.
- Medicaid Compliant Annuity (MCA): Converts countable assets into an income stream for the community spouse, protecting assets while allowing eligibility.
- Caregiver Child Exemption: Transferring the home to a child who has lived with and cared for the applicant for 2+ years may be penalty-free.
- Disabled Child Transfer: Transferring assets to a disabled child or a trust for a disabled child is exempt from look-back penalties.
- Personal Care Agreement: Paying a family member a fair market wage for documented caregiving services provided can be an allowable spend-down method.
- Prepay mortgage & home improvements: Reducing mortgage balance increases home equity (exempt), and making disability-related home improvements reduces countable cash.
Frequently Asked Questions
A Medicaid spend down is the process of reducing your countable assets or income to below your state's Medicaid eligibility limit. For long-term care Medicaid, the asset limit is $2,000 for a single person in most states. If you have $80,000 in savings, you must spend $78,000 on allowable expenses before Medicaid begins paying for your nursing home or home care costs. Once your assets are at or below the limit and you meet clinical eligibility, Medicaid begins covering your care costs.
Most states allow single applicants to have $2,000 in countable assets to qualify for long-term care Medicaid. Exceptions include California (no asset limit), New York ($33,038), Illinois ($17,500), Missouri ($6,069), and Connecticut ($1,600). For married couples where one spouse applies, the community (at-home) spouse can keep a Community Spouse Resource Allowance (CSRA) ranging from $29,724 to $157,920 in 2026. Assets like your primary home, one car, and personal property are typically exempt from the asset count.
Exempt assets that do not count toward Medicaid's asset limit include: your primary home (if you live there or plan to return, up to ~$730,000 equity in most states), one vehicle of any value, personal belongings and household goods, irrevocable prepaid funeral arrangements, wedding/engagement rings, and small life insurance policies. Retirement accounts (IRAs, 401(k)s) are countable in most states unless in active payout status. A spouse's assets up to the CSRA limit are also protected for community spouse protection.
The Medicaid look-back period is 60 months (5 years) before your application date. During this period, the state reviews all asset transfers. If you gave away assets, sold property below market value, or transferred assets to a trust within the past 5 years, Medicaid calculates a penalty period. Penalty = value transferred divided by state average monthly nursing home cost. For example, $90,000 transferred with an $8,929 monthly rate creates a 10.1-month penalty during which Medicaid will not pay. Certain transfers are exempt: transfers to a spouse, to a disabled child, or to a caregiver child who meets specific criteria.
The CSRA protects the at-home spouse when one partner applies for nursing home Medicaid. In 2026, the CSRA ranges from $29,724 to $157,920. Most states use a 50% formula: the community spouse can keep 50% of the couple's total countable assets (at the snapshot date when the ill spouse entered a care facility), up to the state maximum. The ill spouse (applicant) can keep only $2,000 in most states. This prevents the healthy spouse from being impoverished while their partner's nursing home costs are covered by Medicaid.
No. Gifting money to children within the 5-year look-back period creates a Medicaid penalty period. Each amount transferred gets divided by your state's average monthly nursing home cost to calculate penalty months. Transferring $100,000 with an $8,929 monthly rate creates an 11.2-month penalty during which Medicaid will not pay for care. Exempt transfers: assets transferred to a spouse, a disabled child, or a caregiver child who lived with you for at least 2 years before nursing home admission. Consult a certified elder law attorney before any transfers.
Allowable Medicaid spend-down expenditures include: nursing home or care costs, home health aide services, medical equipment (wheelchair, hospital bed, hearing aids), home modifications for disability (ramps, grab bars, stair lifts), paying off a mortgage or debts, prepaying funeral and burial expenses, dental and vision care, legal fees for Medicaid planning, replacing or repairing a vehicle, and household goods. You cannot give money to family members, purchase gifts, or spend on luxury items. Keep all receipts — you will need them for your Medicaid application.
The time to Medicaid eligibility depends on how much you need to spend down and how quickly you spend it. If you enter a nursing home and pay privately while spending down, you reach the asset limit in the number of months equal to your spend-down divided by your out-of-pocket monthly cost (care cost minus income). For example: $60,000 spend-down, $8,929 nursing home cost, $2,000 income = $6,929/month net → approximately 8.7 months. Once assets are at or below the limit and your application is submitted, approval typically takes 30 to 90 days in most states.
Yes, while you are alive. The home is exempt from Medicaid's asset limit if you live there, intend to return, or have a spouse or dependent child living there. Most states limit this exemption to homes with equity under approximately $730,000 (2026). However, after death, Medicaid imposes estate recovery and may seek reimbursement from the estate (including the home) for costs paid. Medicaid Asset Protection Trusts (MAPTs) created more than 5 years before application can protect the home from estate recovery. Consult a certified elder law attorney for state-specific home protection strategies.
Yes. For nursing home Medicaid, most states require applicants to contribute nearly all monthly income toward care costs (keeping only a Personal Needs Allowance of $30 to $200/month). If your income exceeds Medicaid's income limit (approximately $2,829/month in most income-cap states for 2024), you may need a Qualified Income Trust (QIT or Miller Trust) to shelter excess income. In the approximately 36 medically needy states, you can spend down excess income on medical bills each month to reach the income limit. The community spouse typically keeps a Minimum Monthly Maintenance Needs Allowance (MMMNA) of $2,555 to $3,948/month (2026).
A Medicaid Compliant Annuity (MCA) converts countable assets into a stream of income for the community spouse, removing those assets from Medicaid's countable asset calculation. The annuity must be irrevocable, non-assignable, actuarially sound (payments must complete within the annuitant's life expectancy), and name the state Medicaid program as the primary remainder beneficiary after the community spouse. MCAs are used as part of a Medicaid planning strategy to protect assets while achieving eligibility. They must be set up with guidance from a certified elder law attorney to avoid disqualification.
A Medicaid Asset Protection Trust (MAPT) is an irrevocable trust that removes assets from your countable estate for Medicaid purposes, but only after the 5-year look-back period has passed. Assets transferred into a MAPT more than 5 years before a Medicaid application are fully protected from spend-down and from Medicaid estate recovery after death. You typically lose control of the assets but can receive income generated by them. MAPTs must be properly drafted by a certified elder law attorney. They are most effective when created 5 to 10 years before care is anticipated, making early planning essential.
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