The spouse at home's income allowance in Florida: MMMNA, shelter costs and the 2026 cap

The allowance applies when one spouse receives nursing home Medicaid (the Institutional Care Program) or long-term care through Statewide Medicaid Managed Care (SMMC LTC) or PACE, and the other spouse lives in the community (ESS Policy Manual 2640.0119.01). Federal law calls them the institutionalized spouse and the community spouse.

The at-home spouse's own income doesn't count toward the other spouse's eligibility, and income generally belongs to the spouse whose name is on the check (42 U.S.C. 1396r-5(b)). The allowance is about what happens after approval. It decides how much of the patient's income goes to the nursing home as "patient responsibility" and how much may go home. Our married couples guide covers the broader picture, including the $162,660 asset allowance.

DCF uses this formula (ESS Policy Manual 2640.0119.03):

(MMMNA + excess shelter costs) − the at-home spouse's gross income = the income allowance

The excess shelter piece is figured in three steps (2640.0119.04):

Add the at-home spouse's rent or mortgage (principal and interest), property taxes, homeowner's or renter's insurance, condominium maintenance and mandatory homeowners' association fees. Only expenses the at-home spouse actually pays count. If the at-home spouse pays utility bills (water, sewer, gas or electric), add the standard utility allowance of $445 instead of the actual bills. Federal law reduces this to the extent a condominium maintenance charge already includes utilities (42 U.S.C. 1396r-5(d)(4)). Subtract the $812 excess shelter standard. Anything left is the excess shelter cost.

MMMNA plus excess shelter can't exceed the $4,067 cap. In the patient's budget, the $160 personal needs allowance comes off first, then the spouse's allowance, then any family allowance, then allowed medical expenses such as health insurance premiums (42 U.S.C. 1396r-5(d)(1)). Whatever remains is the patient responsibility paid to the nursing home.

Couples sometimes ask whether the spouse at home can keep more savings instead of receiving the patient's income. Federal law answers that. Before a state protects extra assets to produce income for the spouse at home, it must treat all of the patient's income that could be sent home as already sent (42 U.S.C. 1396r-5(d)(6)). DCF applies this by counting the full income allowance as the at-home spouse's income during the hearing, even if the spouse refuses part of it (ESS Policy Manual 2640.0119.02 and 2640.0119.03).

In practice, a larger asset allowance is mostly available in cases like Example C, where both spouses have modest income and the patient's income can't close the gap.

There are two kinds, and both go through a DCF fair hearing.

A higher income allowance. If either spouse shows the at-home spouse needs more income because of "exceptional circumstances resulting in significant financial duress," the hearing officer may set an allowance above the standard (42 U.S.C. 1396r-5(e)(2)(B); ESS Policy Manual 2640.0122). Examples families raise include large uncovered medical costs for the spouse at home, or the cost of a disabled family member living with them. Ordinary living expenses usually aren't enough. A higher asset allowance. If the $162,660 CSRA, plus the income allowance, wouldn't raise the at-home spouse's income to the MMMNA, the asset allowance may be raised to an amount that would (42 U.S.C. 1396r-5(e)(2)(C); ESS Policy Manual 1640.0314.01). How much extra is protected depends on how much income the assets are assumed to earn, which the hearing decides.

Bring documents: bills, leases, tax and insurance statements, medical receipts and income letters. Our crisis planning guide explains where these fit among other options.

Family allowance. If a minor or dependent child, dependent parent or dependent sibling lives with the spouse at home, each may receive one-third of the amount by which the MMMNA exceeds their own income (ESS Policy Manual 2640.0120.02). Court-ordered support. If a court orders the patient to pay support to the spouse at home, the allowance can't be less than the ordered amount (2640.0119.03). Refusing the allowance. The spouse at home may decline all or part of it, but it still counts in a hearing (2640.0119.03). Actually sending the money. The allowance is deducted only to the extent the income is actually made available to the spouse at home (1396r-5(d)(1)(B)). Set up a transfer from the patient's account, or from the QIT if there is one, and keep records.

The dates come from the notes on DCF Appendix A-9 and Appendix A-1. Federal law ties the MMMNA to 150% of the poverty line for two people (42 U.S.C. 1396r-5(d)(3)), and the $812 standard is 30% of that amount. The cap is indexed to inflation (1396r-5(g)). Social Security raises each January also change both spouses' incomes. Check every DCF notice of patient responsibility after these dates, and report changes in rent, taxes or insurance. Our guide to renewals and reporting covers how.