Medicaid Spend-Down 2026: Asset Limit by State, 60-Month Look-Back

What this page adds to our other Medicaid pages

We already cover the spouse's share, home equity cap and penalty divisor state by state on Medicaid 2026 by state: spouse savings, home equity, divisor, and the rules for gifts, trusts and rental property on Medicaid asset protection trusts. What none of them states is the number the applicant's own money is tested against. That is the first step of any spend-down: how far above the line the household is. This page reads that number for 34 jurisdictions, explains what counts and what does not, separates a permitted spend-down from a penalized gift, and works one couple through it. For what happens to the house after death, see Medicaid estate recovery by state; for a policy bought to avoid the problem, see the long-term care Partnership program.

The federal frame, with the 2026 numbers

The $2,000 in the CMS chart is the SSI resource standard. Many states use it for nursing-home Medicaid, but the state chooses, which is why the table below has so many different numbers.

Two kinds of spend-down

Assets. If countable assets are above the state's limit, the household can spend them on the applicant's care, buy things that are not counted, or transfer them in a way the statute allows. This page is about that kind.

Income. If monthly income is above the state's cap, the route depends on the state. The statute describes a trust "composed only of pension, Social Security, and other income to the individual" for states that cover the special income level group but not nursing-facility services for people above it (42 U.S.C. 1396p(d)(4)(B)). Tennessee's manual says that when gross income is greater than its cap "the individual will be provided with the opportunity to establish a Qualified Income Trust"; Alabama publishes a Qualifying Income Trust packet (Form 262); Georgia's manual has a Qualified Income Trust section; and Florida's rule sets the Institutional Care Program income limit at 300 percent of the federal benefit rate. Pennsylvania takes another route: above the cap, "the anticipated cost of long-term care facility services for a 6-month period is an allowable medical expense deduction to reduce monthly income." In Illinois, the policy manual tells caseworkers to enroll community medical cases over the asset limit in "spenddown." Ask which of these your state uses before moving any money; the choice changes who needs a trust.

Individual asset limit for nursing-home Medicaid, by state

Each cell comes from a state agency or rule document that we saved, named in the third column. Not verified means we did not obtain a state document with the number. We did not use law-firm or calculator pages for any cell. Where the document is old or is not the agency's own manual, the date or the type is in the cell.

In 24 of the 34 jurisdictions whose own documents we read, the limit for one nursing-home applicant is $2,000 in countable assets. Four things to read into the exceptions (our reading):

• California is the large one. Its Medi-Cal page says assets started to count on January 1, 2026. It says the same asset limit applies to people who live in a nursing home, and that giving away assets for less than they are worth "could delay your long-term care coverage." The $21,000 figure from July 1, 2027 is on the same page. Our asset protection page states the $130,000 start without the 2027 step down.
• Illinois and New York are high on purpose. Illinois raised the figure from $2,000 to $17,500 for medical cases effective May 12, 2023; New York revised its figure when the 2026 federal poverty levels were published (GIS 26 MA/05), so it moved between two notices in 2026.
• Maryland publishes two schedules. The medically needy schedule shows $2,500 and the categorically needy schedule $2,000. The manual page we read does not say which one a nursing-home applicant is tested against.
• A low limit is not always the end of the story. Pennsylvania adds a $6,000 disregard; Washington's rule allows a higher standard for a person with a qualified long-term care partnership policy.

What counts and what does not

The limit applies to countable assets. State documents agree on the broad shape and differ on the edges:

The home is the item that decides most families' plans. It is generally not counted while the applicant intends to return or a spouse lives there, but the equity cap still applies to the applicant (the range is $752,000 to $1,130,000 in 2026), and an exempt house can still be a gift problem if title moves. For the cap by state, see our spouse and home equity page.

Permitted spend-down versus a penalized transfer

The statute's trigger is a disposal "for less than fair market value." Our reading: paying the nursing home, medical bills and debts, or buying something at its market price, is an exchange for value and is not a transfer for less than fair market value. A gift to a child is. The statute exempts specific transfers:

A transfer to a spouse does not remove the money from the test: the spouse's share is computed from the couple's total at the start of the first continuous period of institutionalization (42 U.S.C. 1396r-5(c)(1)(B)), and the spouse's share is capped. Transfers to children are where the look-back bites, and the length of the penalty depends on the state's divisor, which our divisor page lists for the states whose documents we could read.

Worked example: a couple with a house and $300,000 (our arithmetic)

Assume a couple in Pennsylvania. One spouse enters a nursing home; the other stays in the house. The house is worth $400,000 (under $752,000, and a spouse lives there), they own one car, and they have $300,000 in savings and investments that count. Pennsylvania's page says the spouse's share is one-half of the couple's countable resources, no less than $32,532 and no more than $162,660 for 2026, and that the resource limit is $2,000 for one person.

Example A: $300,000 minus $150,000 minus $2,000 is $148,000 that has to be used or protected before the applicant qualifies. The house, the car and the spouse's $150,000 do not have to be sold. We did not apply Pennsylvania's $6,000 disregard; if it applies to this household the excess would be lower, and the county assistance office decides. Example B shows how the cap changes the result: half of $500,000 is $250,000, but the spouse keeps $162,660, so $335,340 is above the line. Example C shows the floor: half of $60,000 is $30,000, but the spouse keeps $32,532.

What a household can do with the $148,000 is the point of the planning: pay for care while the applicant is private-pay, pay debts and repairs, or make an allowed transfer from the table above. If the household instead gives $148,000 to a child inside the look-back, the penalty is $148,000 divided by Pennsylvania's average daily private pay rate (Pennsylvania's page does not state that rate), so we do not compute a number. The point is that a gift turns an amount that was above the line into months with no coverage, and the care still has to be paid for during them.

What changed recently

• California (January 1, 2026): assets count again; $130,000 for one person through June 30, 2027; $21,000 from July 1, 2027. Gifts for less than they are worth can delay long-term care coverage from January 1, 2026.
• New York (February 13, 2026): the resource figure moved from $32,396 to $33,038.
• CMS (2026): the spouse's range rose to $32,532 to $162,660, and the minimum monthly maintenance allowance rose to $2,705.00 on July 1, 2026.
• Illinois (May 12, 2023): $17,500, still in the policy manual.

What this means for the decision

What the documents make decisive (our reading, not a recommendation):

• The state, then the date. The same household is $148,000 over the line in one state and under it in another. California's step down in July 2027 changes the answer for anyone who waits.
• Whether a spouse stays home. The spouse's share and the home exemption exist for the spouse at home; a single applicant gets neither.
• How long ago money moved. Anything given away inside 60 months is reviewed. Money moved four years ago is a different problem from money moved last month.
• Income as well as assets. An income-cap state can require a trust even when the assets are fine.
• A policy is a separate lever. See our page on hybrid long-term care insurance.

Eligibility is decided by the state agency, and the legal documents are drafted by an elder law attorney licensed in your state. The match below connects you with financial advisers who can look at the whole balance sheet: how much to keep to pay for care, what selling a house or a rental costs in tax, and what to do with the spouse's protected share. An adviser does not decide eligibility and does not draft legal documents. If you already have an attorney, bring the row for your state to that meeting.

This is analysis of public documents, not investment, legal or tax advice.

What a reader can do with this

• Find your state's row and open the state document in the third column. If it says not verified, ask the Medicaid office for the current resource limit for nursing-home Medicaid and the date of the chart.
• List countable assets on the first day of the care episode. Include accounts, investments, second properties and cash value of life insurance; leave out the main home and one car. The spouse's share is measured at the start of the first continuous period of institutionalization (42 U.S.C. 1396r-5(c)(1)(B)).
• Ask for the resource assessment. Pennsylvania, for example, has a Resource Assessment Form (PA 1572) to set the spouse's share. Other states have their own.
• Do the subtraction. Half of the couple's total, bounded by $32,532 and $162,660, is the spouse's share; add the applicant's limit; the rest is above the line (our arithmetic above).
• List every gift in the last 60 months with date and amount before applying; all of them are added together.
• Check income against the cap, $2,982 a month for one person in 2026, and ask which route your state uses above it.
• Do not fill a blank from a blog. The number that matters sits on a state page that changes.

FAQ

Sources, read and saved on November 9, 2026: CMS CMCS Informational Bulletins of December 9, 2025 and April 27, 2026 (medicaid.gov, 2026 SSI and Spousal Impoverishment Standards); 42 U.S.C. 1396p and 1396r-5 (law.cornell.edu copy of the U.S. Code); Alabama Medicaid Agency Institutional Medicaid page; Alaska 7 AAC 40.270 and 7 AAC 100.400 (law.cornell.edu copy); Colorado 10 CCR 2505-10 section 8.100 (law.cornell.edu copy); Kentucky 907 KAR 20:025, Massachusetts 130 CMR 519.006, Nebraska 477 NAC chapter 26, New Jersey N.J.A.C. 10:71-4.5, South Dakota ARSD 67:46:05:30 and Utah Admin. Code R414-305-3 (law.cornell.edu copies); Oklahoma OKDHS Nursing Facility Care page; California DHCS Medi-Cal asset limit FAQ (through the Internet Archive); Connecticut DSS brochure W-1659; District of Columbia DHCF long-term care page; Florida Administrative Code 65A-1.712 and 65A-1.716; Georgia DFCS Appendix A1 (2026); Idaho Department of Health and Welfare Medicaid income limits page; Illinois IDHS Policy Manual PM 07-02-01; Iowa HHS Comm. 072; Louisiana Department of Health long-term care FAQ; Maryland Medical Assistance Manual schedules (2026); Minnesota House Research Department publication of September 2025; Montana DPHHS CMA 001; Nevada Medicaid Services Manual F-100; New York DOH GIS 26 MA/03 and 26 MA/05; North Dakota HHS Medicaid eligibility page; Ohio Administrative Code 5160:1-3-05.1 and MEPL 191; Oregon Administrative Rule 461-160-0015; Pennsylvania DHS page on Medical Assistance and payment of long-term care; Rhode Island 210-RICR-50-00-6; TennCare Institutional Medicaid manual; Texas HHSC MEPD Handbook F-1300; Virginia DMAS Transmittal 37; Washington WAC 182-513-1350; West Virginia Bureau for Family Assistance long-term care document. Other jurisdictions are marked not verified.