Medicaid Spend-Down Calculator: Do You Qualify for Long-Term-Care Medicaid? — Kentucky

A Medicaid spend-down calculator estimates how much of your countable assets must be spent before institutional (long-term care) Medicaid begins paying for a nursing home. It applies your state's actual 2026 asset limit (federal default $2,000; California $130,000; New York $33,038; Illinois $17,500; others vary), the Community Spouse Resource Allowance ($32,532-$162,660 under 42 U.S.C. §1924(f)(2)), your state's home equity limit ($752,000 federal minimum, $1,130,000 maximum), and the institutional income cap ($2,982/month in 2026) to show the exact spend-down target.

Medicaid separates your assets into countable (cash, investments, second home, non-residence real estate, cash-value life insurance above $1,500, retirement accounts in most states) and exempt (primary residence up to state equity limit, one vehicle, household goods, term life, irrevocable burial trust). Countable assets above your state's applicant limit (plus CSRA if married) must be spent before Medicaid pays. Money can be spent on care, exempt purchases (home repairs, dental, new car, prepaid burial), or protected transfers to a disabled child, caretaker child, or Medicaid Asset Protection Trust funded 5+ years before application.

The Community Spouse Resource Allowance (CSRA) protects the well spouse's share of countable assets. In 2026, CSRA is half of the couple's total countable assets, bounded by federal minimum $32,532 and maximum $162,660 (42 U.S.C. §1924(f)(2)). A few states use only the maximum ($162,660) — Illinois, Massachusetts, New York use the max as the floor. The well spouse keeps their share fully; only the applicant's share above their state-specific asset limit ($2,000-$130,000 depending on state) must be spent.

The 60-month lookback under 42 U.S.C. §1396p(c) reviews every asset transfer in the 5 years before Medicaid application. Any gift, below-market sale, or funding of an irrevocable trust triggers a penalty period during which Medicaid will not pay. Penalty period = transferred value ÷ state's monthly divisor (California $14,440/mo, Texas $7,900, Florida $10,645, New York $16,229). Exceptions: transfers to a spouse, disabled child, caretaker child living in the home 2+ years, or a sibling with equity interest living in the home 1+ year.

A Qualified Income Trust (Miller Trust) under 42 U.S.C. §1396p(d)(4)(B) is required in the ~20 income-cap states (Alabama, Alaska, Arizona, Colorado, Delaware, Florida, Georgia, Idaho, Indiana, Iowa, Louisiana, Mississippi, Nevada, New Mexico, Oklahoma, Oregon, South Carolina, South Dakota, Texas, Wyoming) when the applicant's monthly income exceeds $2,982 (300% of the 2026 SSI FBR $994). Each month, income above the cap flows into the trust, then out to the nursing home. Miller Trusts are drafted before application, funded monthly, and terminate at death with any remainder subject to Medicaid payback.

Generally yes if you intend to return home or a spouse/dependent lives there. The home is exempt regardless of value if a community spouse resides. If single, home equity is exempt up to your state's limit — $752,000 in 38 states (federal minimum), $1,130,000 in the 12 max-limit states (Alabama, California, Colorado, Connecticut, Hawaii, Maine, Massachusetts, New Jersey, New York, Tennessee, Washington, plus D.C.). Equity above the limit blocks Medicaid unless a HELOC or spousal transfer reduces it. After death, Medicaid Estate Recovery under 42 U.S.C. §1396p(b) can claim against the home unless a protected transfer (life estate deed 5+ years before, ladybird deed in eligible states, or transfer to caretaker child) applies.

It depends on which spend-down applies to you. Asset spend-down — reducing countable assets below your state's resource limit (and below the CSRA, if married) — is a one-time threshold: once countable assets are under the limit, you don't spend down again. The calculator's asset and marital-status inputs above compute that one-time target. Income spend-down works differently. In medically-needy states (the states without a hard income cap), Medicaid compares monthly income to the state's Medically Needy Income Level (MNIL) — as low as $100/month in Louisiana, as high as $1,842/month in New York — and any income above MNIL must be spent on medical costs each month, sometimes called a 'share of cost.' Because it's tied to ongoing income rather than a one-time asset balance, this income spend-down recurs every month (or every eligibility period the state uses), not just once. In the roughly 20 income-cap states, income above the $2,982/month cap isn't spent down at all — it's redirected each month into a Miller Trust instead. Either way, if your state uses income-based eligibility, plan for a recurring monthly process on top of — not instead of — the one-time asset spend-down shown above.