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Medicaid Planning When a Spouse Enters a Nursing Home: Avoiding Costly Pitfalls to Preserve Spousal Income

CSRA, Monthly Maintenance Needs Allowance, Exempt Asset Requirements, and More

Recording of a 90-minute CLE video webinar with Q&A

This program is included with the Strafford CLE Pass. Click for more information.
This program is included with the Strafford All-Access Pass. Click for more information.

Conducted on Thursday, May 26, 2022

Recorded event now available

or call 1-800-926-7926

This CLE course will provide elder law counsel with the tools to assist their married clients in Medicaid planning when one spouse enters a nursing home. The program will discuss how to best leverage the community spouse resource allowance (CSRA) and Medicaid monthly minimum maintenance needs allowance (MMMNA) and how to comprehensively identify exempt assets and avoid spending down exempt funds. The program will discuss other approaches to maintain assets and income for the healthy spouse.


The spend-down of assets for Medicaid qualification causes much confusion. Practitioners advising the senior population must understand new medical criteria, qualification standards for Medicaid, and how assets are classified.

Asset protection strategy implementation requires a working knowledge of how the spend-down is determined. Rules for married couples are particularly complicated when one spouse enters a nursing home or long-term care facility. Counsel's goal is to preserve as much income and assets for the healthy spouse as permitted under the law.

Fundamental approaches include making countable assets unavailable and leveraging the use of the CSRA and MMMNA. Other strategies include transferring the sick spouse's IRA/retirement funds to the healthy spouse, having a valid, well-crafted power of attorney, considering divorce as an asset-protection option, and revising the estate plan.

Listen as our distinguished panel of attorneys discusses tools to assist married clients in Medicaid planning when only one spouse enters a nursing home. The speakers will provide tips for leveraging the CSRA and MMMNA, identifying exempt assets, and avoiding spending down exempt resources. The panel will also cover other strategies to maintain assets and income for the healthy spouse.



  1. Community spouse resource allowance: determine snapshot date
    1. Avoid purchasing exempt assets before the date of admission if that is snapshot date
    2. Case study--spouses with less than max CSRA
    3. Case study--spouses with more than max CSRA
  2. Monthly maintenance needs allowance: using nonexempt assets to protect the spouse's income
  3. Avoid spending down exempt resources
  4. Identifying earliest date for Medicaid qualification
  5. Identifying all exempt transfers
  6. Sufficient power of attorney
  7. Divorce as a strategy
  8. Pre-planning vs. crisis planning
  9. Revising the estate plan
    1. Disinheriting the sick spouse
    2. Removing the sick spouse from fiduciary roles


The panel will review these and other critical issues:

  • How can the CSRA be optimized for the married client's benefit?
  • When is divorce a viable option in a spend-down strategy?
  • How does the strategy differ between nursing home pre-planning vs. crisis planning?


Dowell, Shelley
Shelley Dowell

Kentucky ElderLaw

Ms. Dowell assists older clients, their children and other family members with Nursing Home, Medicaid, asset...  |  Read More

Keenan, Michael
Michael J. Keenan

Keenan Law

Mr. Keenan specializes in elder law, estate planning, special needs trusts and probate law. He has written...  |  Read More

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