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Appendix A-17-3 Revised January 2026 SPOUSAL RESOURCE and INCOME RULES

The following Medicaid rules apply to a legally married couple when:

• One spouse enters a nursing facility or hospital for 31 days or longer or enrolls in a Home & Community Based Waiver (referred to as the Institutional Spouse or IS), and

• The other spouse remains in the community and lives at home or with others or in a retirement community (referred to as the Community Spouse or CS).

For these rules to apply, an application for Medicaid must be filed and:

• The IS must have entered a nursing facility or hospital, or • The IS and CS must live together in the same household if the IS applies for a Home & Community Based Waiver program. Resource Rules

The value of all countable resources belonging to the IS and the CS must be determined.

This includes countable resources owned jointly or individually by the couple or their fair share of any resources owned with other persons. The equity value of a resource counts, i.e., the current market value of a resource less any legal debts owed.

Once the equity value of each countable resource is verified, the total value of spousal resources is determined and compared to the following limits:

• The IS resource limit is $4,000, and • The CS resource limit is $162,660 for calendar year 2026. Any amount over the combined total of these 2 limits is considered to be available to the IS, meaning the IS cannot be eligible until excess resources are spent.

If the CS also plans to apply for Medicaid, the CS resource limit may not apply. The CS must be below the resource limit that applies to the at-home Medicaid coverage group

Electronic Verification of Financial Accounts

When you sign the application for Medicaid, you give the Division of Medicaid consent to verify funds held in a financial institution, such as banks and credit unions, through electronic matching of Social Security Numbers belonging to both the IS and CS. Account balances, including balances during the 5-years prior to applying for Medicaid, are used to determine if any accounts have been given away and are used to determine current eligibility for the IS. There are instances that