How Does Spouse Income Affect Medicaid Eligibility in PA

Certified as an elder law attorney by the National Elder Law Foundation under authorization of the Pennsylvania Supreme Court

Certified as an elder law attorney by the National Elder Law Foundation under authorization of the Pennsylvania Supreme Court

This blog is the fifth chapter of a series entitled “How to Qualify for Medicaid in Pennsylvania” that focuses specifically on the program for long-term care. Qualifying for Medicaid can be confusing and complicated, but this guide explains it in plain English.  If you would like to order a copy of the complete guide click here.

Monthly Maintenance Needs Allowance

Medicaid law has another anti-impoverishment provision for the community spouse. In addition to the community spouse resource allowance, which allows the community spouse to keep a certain amount of assets, the community spouse is also entitled to a “monthly maintenance needs allowance” (MMNA for short) that allows for a certain amount of income.

community spouse

Definition: The MMNA is an amount of monthly income that a community spouse is entitled to receive. It is calculated on an individual basis, so it is not the same amount for every community spouse. The amount is calculated using the community spouse’s “shelter expenses,” including rent or mortgage payments (including principal and interest), taxes and insurance, required maintenance charges for a condominium or cooperative, and utility expenses.

**Bottom Line: What Most People Need to Know About the MMNA**

The MMNA can be calculated for each community spouse. It will be at least the current minimum ($2,178 until June 30, 2022) but no more than the current maximum ($3,254 until December 31, 2021). It will usually fall somewhere between those two numbers. To get an idea about how it works, see the examples later in this post. If the community spouse’s income is below the MMNA, the difference can come from the institutionalized spouse’s income. In the event there is still too little income (after taking the institutionalized spouse’s income) to meet the MMNA, the community spouse may keep additional countable assets.

How the MMNA is Calculated

In general, a community spouse who has higher shelter expenses will have a higher MMNA. For instance, a community spouse who rents will usually have higher shelter expenses than someone who lives in a house with no mortgage. The renter will likely have the higher MMNA. You don’t have to calculate your own MMNA. The caseworker will calculate it for the community spouse based upon the information in the Medicaid application. But if you’re interested in the details, here is the basic calculation:

Basic allowance (current minimum figure)


Community spouse’s allowable shelter costs


Current shelter standard


Community spouse’s MMNA

If you want to do the full calculation of your own MMNA, Appendix C for a worksheet that will walk you through the numbers.

Example #1: Joe, the community spouse, lives in the home he and his wife bought 45 years ago. The mortgage has been paid off. Real estate taxes for the most recent year are $4,932, averaging $411 a month. Joe pays $876 a year for homeowner’s insurance, averaging $73 a month. He pays all utility bills each month, including gas, electric, water, sewage, etc. Therefore he uses the Standard Utility Allowance of $612 per month.

 Joe’s MMNA = $2,620

The basic calculation is:

Basic allowance:      $2,178
Plus Joe’s allowable shelter costs      +$1,096
Minus current shelter standard      -$654
Joe’s MMNA      $2,620

For Joe’s full calculation, see Appendix C-1.

Example #2: Mary, the community spouse, rents an apartment for $1,250 a month. Mary pays $612 a year for renter’s insurance, averaging $51 a month. Heating and cooling costs, such as gas and electric, are included in her rent. She pays other utility bills each month, including phone, water, garbage removal, etc. Therefore she uses the Standard Utility Allowance of $317 per month.

Mary’s MMNA = $3,142

The basic calculation is:

Basic allowance:      $2,178
Plus Mary’s allowable shelter costs     +$1,618
Minus current shelter standard     -$654
Mary’s MMNA     $3,142

For Mary’s full calculation, see Appendix C-2.

The Income Gap

Quite often a gap exists between the MMNA a community spouse is entitled to receive, and his or her actual income. For example, the wife of a breadwinner on Medicaid may have a MMNA of $2,500 but receive only $700 a month in Social Security. Where does the other $1,800 come from? First, the community spouse can receive income from the spouse on Medicaid (from income left after paying for such things as health insurance premiums and a personal needs allowance). If a gap still remains, the community spouse can receive some of the couple’s “excess resources” that have not yet been spent down. The amount that can be kept depends on such things as the amount of the gap, the spouse’s gender and age, as well as other factors. It’s best to get advice from an attorney experienced in Pennsylvania Medicaid procedures for help on this issue.

Can the MMNA ever exceed the maximum?

A community spouse who has “exceptional circumstances resulting in significant financial duress” may request a MMNA that exceeds the maximum cap.

In Pennsylvania, approval for a MMNA exceeding the maximum requires a hearing before an administrative law judge (ALJ for short). The caseworker processing the application has no authority to exceed the maximum. Once the caseworker has approved the application and calculated the MMNA, the community spouse can then file an appeal and have a hearing on the request to exceed the maximum.

For example, suppose the community spouse has significant care needs and her doctor has stated that she must live in an assisted living (or other similar) care facility. The cost of that facility exceeds the current 2021 maximum MMNA of $3,259. She, or someone on her behalf, could request a higher MMNA to pay for her monthly care costs.

Whether such a request would be approved is up to the ALJ (whose decision can also be appealed).

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