Medicaid Spend-Down Calculator: Income Trust or Spend-Down, by State

Updated September 7, 2026. Quick answer: there is no national Medicaid spend-down number, because there are two different machines and every state runs one of them. In 23 states an applicant whose income is over the limit is not allowed to spend it down at all; the only route is an income trust, and the state has its own name for it. In the other 28 the trust is not available and the excess becomes a spend-down, deductible or patient liability, computed over an accounting period the state fixes. Federal law decides which machine you are on: 42 U.S.C. 1396p(d)(4)(B)(iii) makes the trust available only in a state that runs the institutional income group but does not make medically needy coverage available for nursing facility services. The calculator below tells you which machine your state runs, in every one of the 51. It puts a dollar figure on 11 of them and refuses the other 40, for reasons it states one state at a time.

The calculator

Enter the income paid in the applicant’s own name, not the household’s. That is the figure the institutional income test is run on: “During any month in which an institutionalized spouse is in the institution, except as provided in paragraph (2), no income of the community spouse shall be deemed available to the institutionalized spouse.”

Two machines, and the federal rule that decides which one you are on

The institutional eligibility group is 42 U.S.C. 1396a(a)(10)(A)(ii)(V): people in a medical institution for at least thirty consecutive days whose income does not exceed “a separate income standard established by the State which is consistent with the limit established under section 1396b(f)(4)(C)”. That cross-reference is where the famous three-hundred-percent figure comes from. Section 1396b(f)(4)(C) caps the standard at income that “does not exceed 300 percent of the supplemental security income benefit rate established by section 1382(b)(1) of this title”.

So the ceiling is a percentage, not a dollar, and the dollar moves every January with the SSI federal benefit rate. The Social Security Administration’s own notice for 2026 sets that rate at $994 a month for an eligible individual and $1,491 for an eligible individual with an eligible spouse. Three times $994 is $2,982. Two and a half times it, which is what Delaware uses instead, is $2,485. Any page quoting a flat national Medicaid income limit is quoting one state’s arithmetic and hoping.

The second rule is the one that decides whether a trust is even on the table. 42 U.S.C. 1396p(d)(4)(B) exempts a trust that is “composed only of pension, Social Security, and other income to the individual”, that repays the state on death, and, critically, only where the state “makes medical assistance available to individuals described in section 1396a(a)(10)(A)(ii)(V) of this title, but does not make such assistance available to individuals for nursing facility services under section 1396a(a)(10)(C)”. Run a medically needy programme for nursing facility care and the Miller trust is not available in your state, as a matter of federal law. That is not a theory: Louisiana’s own manual dates the switch, telling caseworkers that trusts “are no longer applicable due to the re-implementation of a Title XIX Medically Needy Program”, and New Jersey’s dates the opposite switch, adopting trusts in December 2014 to “replace the Medically Needy eligibility program used for nursing facilities”.

What marital status changes, and what it does not

It does not change the limit. It changes whose income is measured against it. The spousal impoverishment statute, 42 U.S.C. 1396r-5(b)(1), is explicit: “During any month in which an institutionalized spouse is in the institution, except as provided in paragraph (2), no income of the community spouse shall be deemed available to the institutionalized spouse.” So a married applicant whose spouse stays at home is tested on their own income alone, and a large community-spouse pension does not push them over anything.

Where income is paid in both names, 1396r-5(b)(2)(A)(ii) attributes “one-half of the income” to each spouse, and the calculator counts half when you enter it. Read that attribution rule for what it is: the statute introduces subsection (b)(2) as applying “for purposes of the post-eligibility income determination described in subsection (d)”. The eligibility rule the statute states in its own voice is (b)(1), the no-deeming rule quoted above. We apply the halving because it is the only attribution rule Congress wrote, and we tell you where Congress put it.

If both spouses are in care, the statute does not apply at all. Its definition at 1396r-5(h)(1) reaches only someone who “is married to a spouse who is not in a medical institution or nursing facility”, so two institutionalised spouses are each tested on their own income under the ordinary rules.

The 40 states this tool will not put a number on

A calculator that guesses is worse than a table. These are the states where the source this family reads does not publish the standard, or publishes something that is not a ceiling, and each one says which on screen. Three of the refusals are worth naming here because they are not gaps, they are findings.

• Minnesota is refused after a refutation. The Department of Human Services page cited for a $2,982 Special Income Standard was re-read at its own address on September 6, 2026. It states the rule, that the standard “is equal to three times the Supplemental Security Income Federal Benefit Rate”, and then gives a 2023 figure, for the Elderly Waiver. It is not the nursing-facility ceiling and we will not print it as one.
• New Hampshire publishes a protected income level of $888 a month for an assistance group of one, at He-W 858.04, Table 600.11, and we read it. The same rule says the protected income levels determine eligibility for medically needy assistance “with the exception of individuals eligible for nursing facility care”, who are determined under He-W 858.05. The number is real and it is the wrong number for this question.
• Virginia is refused because there are three of it. 12 VAC 30-40-220 sets, for a family of one, Group I at $2,691.00, Group II at $3,105.00 and Group III at $4,036.50, by locality. There is no single Virginia figure to subtract from, and picking one would be picking a place to live for you.

Montana belongs with them for a different reason. Its own Table of Standards sets a $30 categorically needy institutional standard and a $525 medically needy income level, and then states that institutionalised individuals are income-eligible “so long as their monthly nursing home costs equal or exceed their monthly income”. Neither number is a ceiling. The real Montana test is the cost of care.

What this tool does not do

It does not decide eligibility. Income is one of at least four tests and it is the only one modelled here: the asset test, the level-of-care test and the five-year transfer-of-assets look-back are separate, and passing this one clears none of them.

It does not compute what you will pay. In an income-cap state the trust changes which pot the money sits in for the eligibility test; the post-eligibility rules still send almost all of it to the facility. In a spend-down state the excess is met with incurred medical expenses, which for a nursing-home resident usually means the cost of care itself, so the arithmetic here is the size of the obligation, not a cheque.

It does not price the personal needs allowance, the community spouse’s income allowance or the health-insurance premium deduction, which come off the post-eligibility computation and not off this one. It does not know your state’s asset limit. And it carries no advertising and no referral of any kind: this is an eligibility-arithmetic page, and the reader is a family member pricing a rule, not a person shopping for a product.

Every state, side by side

The route column is complete: 51 of 51. The figure column is deliberately not, and the accounting-period column carries a period only where that state’s own rule states one, which is 11 of them.

Scope, method and sources

Each state’s route, the name it uses for its own instrument, and the rule quoted on screen come from that state’s own record in this site’s excess income rule series, one page per jurisdiction, each built from that state’s own manual, regulation or statute. The quotations here are lifted from those pages by the build script rather than retyped, and the build refuses to run if a name, figure or period claimed for a state does not appear in that state’s own text, which is how a Louisiana word cannot end up in a Vermont row.

The federal chain was read at source on September 6, 2026: 42 U.S.C. § 1396a(a)(10)(A)(ii)(V) (Cornell LII); 42 U.S.C. § 1396b(f)(4)(C) (Cornell LII); 42 U.S.C. § 1396p(d)(4)(B) (Cornell LII); 42 U.S.C. § 1396r-5(b), (h) (Cornell LII); and Social Security Administration, “Cost-of-Living Increase and Other Determinations for 2026”, 90 FR (document 2025-19763), published November 3, 2025 for the 2026 SSI federal benefit rate. The state figures the calculator uses were each re-read at their own origin the same day: Delaware, Florida, Idaho, Illinois, Kentucky, Maryland, North Dakota, Oklahoma, Rhode Island, Washington and Wisconsin.

Where a state’s figure could not be re-read at origin that day, no figure is printed. That is the whole of the rule, and it is why 11 of 51 carry a number.

Nothing here is legal advice, eligibility is decided by the state agency on the whole file, and no one should move, retitle or assign income on the strength of a web page.