Long-Term Care Medicaid and Protecting the Community Spouse in Southern New England

"Medicaid plays a crucial role in helping families afford long-term care across the United States. Still, its importance is especially pronounced in the densely populated and aging communities of southern New England," stated professional fiduciary and certified elder law Attorney RJ Connelly III. "For families in Connecticut, Massachusetts, and Rhode Island, protecting the community spouse—the husband or wife who remains at home when their partner enters a nursing home—is fundamental to adequate financial and long-term care planning."

This blog examines the specific regulations, provisions, and strategies relevant to residents of Southern New England as they navigate the Medicaid system and the provisions made for the community spouse.

Who Is the Community Spouse?

In the context of Medicaid long-term care eligibility in southern New England, the “community spouse” is the individual who continues to reside at home while their husband or wife, known as the “institutionalized spouse,” receives care in a nursing facility. The community spouse’s financial well-being is a clear priority for each state’s Medicaid program, which follows federal guidelines but also includes important local nuances.

The Spousal Impoverishment Problem in New England

Due to the high cost of nursing home care in Connecticut, Massachusetts, and Rhode Island—often exceeding $12,000 per month—families face the real risk of depleting their savings. If not for Medicaid’s spousal impoverishment protections, the spouse at home could be left with little to live on once their partner qualifies for public assistance. Congress addressed this nationally in the late 1980s, but each state’s implementation matters—especially in high-cost regions like New England.

Key Spousal Protections in Southern New England

Medicaid’s primary spousal protections are the Community Spouse Resource Allowance (CSRA) and the Minimum Monthly Maintenance Needs Allowance (MMMNA). While federal rules set parameters, each state in southern New England applies its own numbers, updated annually.

Community Spouse Resource Allowance (CSRA)

The Community Spouse Resource Allowance (CSRA) is designed to help married couples protect some of their joint assets when one spouse needs long-term care and applies for Medicaid. This allowance prevents the healthy spouse, known as the "community spouse," from becoming impoverished due to Medicaid's asset spend-down requirement. The amount of the CSRA varies by state, with national maximums and minimums established by the government. This allowance can be used for essential expenses such as housing and food.

Connecticut: In 2025, a community spouse may retain up to $154,140 in countable assets, or half of the couple’s combined resources, whichever is less. However, there is a floor of $30,828. Assets above this amount generally need to be spent down before Medicaid eligibility is attained. Still, certain types of property (such as the primary residence, if the community spouse remains in the home) are exempt.

Massachusetts: The CSRA maximum for 2025 is also $154,140, with a similar floor. Massachusetts MassHealth considers the couple’s assets at the time of the Medicaid application, and those assets must be retitled or spent down appropriately.

Rhode Island: The maximum CSRI in Rhode Island for 2025 is $157,920. This allows the non-applicant spouse to keep up to this amount of assets while their partner qualifies for Medicaid long-term care. The minimum CSRA for 2025 is $31,584. 

In all three states, careful planning is needed to ensure assets are correctly allocated before application, as improper transfers or timing can result in a penalty period of Medicaid ineligibility.

Minimum Monthly Maintenance Needs Allowance (MMMNA)

The Minimum Monthly Maintenance Needs Allowance (MMMNA) is a Medicaid regulation that protects a community spouse from financial hardship when their partner needs long-term care. It allows the community spouse to retain a portion of the institutionalized spouse's income to cover essential living expenses if the institutionalized spouse's income falls below a specified threshold. The MMMNA amount is state-specific and adjusted annually for inflation.

Connecticut: The 2025 MMMNA is $2,465 per month but may be higher based on housing and utility costs, with a maximum of $3,853.50. If the community spouse’s income is below this, a portion of the institutionalized spouse’s income can be diverted to bring them up to the MMMNA.

Massachusetts: The MMMNA starts at $2,465, and similar adjustments are allowed. MassHealth calculates allowance based on the spouse’s shelter and utility expenses.

Rhode Island: The MMMNA is not a single figure for all of Rhode Island in 2025, as it is calculated individually for each couple. The allowance ensures a community spouse has enough income to live on, and the figure for 2025 is generally cited as being around $3,948 per month, but this is a guideline and the actual amount depends on the community spouse's needs and the couple's income.

Practical Example: The Smiths of Massachusetts

Imagine John and Mary Smith from Worcester, MA. John requires nursing home care costing $14,000 per month. They have $130,000 in savings. When John applies for MassHealth (Medicaid in Massachusetts):

• Mary can keep $65,000 (half their assets, under the CSRA maximum).

• Their home remains exempt as long as Mary lives there.

• If Mary’s monthly income is $1,500, but the MMMNA is $2,465, John’s pension and Social Security may be partially allocated to Mary until her income reaches the required threshold. This ensures Mary can afford to stay in her home and meet her living expenses.

Common Misconceptions in Southern New England

Despite robust protections, many New Englanders believe that Medicaid will force the sale of the family home or require the community spouse to deplete all assets. In practice, as long as the community spouse remains in the house, it is not counted as an asset for eligibility. However, states like Massachusetts and Connecticut have estate recovery rules, meaning that Medicaid may seek reimbursement from the estate after both spouses have passed away. It’s essential to be aware of these provisions and plan accordingly with an experienced elder law attorney.

Planning Strategies for New England Residents

Working with an elder law attorney who understands the nuances of Connecticut, Massachusetts, or Rhode Island Medicaid is invaluable. Strategies may include:

• Re-titling assets and spending down non-exempt resources on home improvements, vehicles, or pre-paid funeral plans

• Establishing a Medicaid-compliant annuity or trust

• Knowing the five-year look-back period for asset transfers, which is strictly enforced in New England states

• Appealing for an increased MMMNA due to exceptional shelter costs

  
  

A Final Note

"Navigating Medicaid and protecting the community spouse in southern New England requires both a clear understanding of the rules and strategic, state-specific planning," said Attorney Connelly. "With some of the highest long-term care costs in the nation, Connecticut, Massachusetts, and Rhode Island families must be proactive. Consulting with an experienced and knowledgeable elder law attorney can mean the difference between financial security and unnecessary hardship. By making informed decisions, New Englanders can ensure that both spouses are protected and that their dignity is preserved as they age."

The information presented within this blog is intended exclusively for general informational purposes and should not be construed as legal, financial, or healthcare advice. The content, materials, and insights provided may not reflect the most recent developments in these fields and, therefore, should not be relied upon for personal or professional decisions. Further, this blog may contain links to third-party websites, which are included solely for the convenience of our readers. It is essential to note that Connelly Law Offices, Ltd. does not automatically endorse or recommend the contents of these external sites. Given the complexities and nuances of legal, financial, or healthcare matters, we strongly encourage individuals to consult a qualified attorney, a professional fiduciary advisor, or a healthcare provider regarding any specific issues or concerns. Your well-being and informed decision-making are of paramount importance to us.