How does MaineCare treat spouses and partners in household composition?
This fact-check may be outdated. Consider refreshing it to get the most current information.
Executive summary
MaineCare (Maine’s Medicaid) determines eligibility and household composition by looking at household size, tax-filing relationships and who lives together — and treats spouses differently depending on the program (regular MaineCare vs. long‑term care/nursing home rules). Household income limits and whether a spouse is an applicant or community (non‑applicant) spouse affect countable income and assets; for long‑term care, MaineCare applies spousal protections like the Community Spouse Resource Allowance and income allowances [1] [2] [3].
1. How “household” and relationships drive eligibility — basic rules
MaineCare’s intake and eligibility rules require examiners to consider household income, tax filing status and relationships between household members when determining eligibility for each applicant. That means whether someone is a spouse, tax dependent, or lives in the same household can change which incomes are counted and which income limits apply [1] [4].
2. Spouses in routine (non‑long‑term) MaineCare: joint counting and tax status matter
For most MaineCare coverage groups, household composition is anchored to the number of people in the family unit and their tax filing relationships. The program looks at household income and who claims whom on taxes to set the household size used for income limits; therefore a married couple’s incomes and tax filing choices can directly affect eligibility for each partner [1] [5].
3. Long‑term care (nursing home) rules treat spouses with special protections
When one spouse applies for long‑term care MaineCare, the non‑applicant “community spouse” receives statutory protections: Maine applies resource/countable‑asset rules to both spouses and sets allowances so the community spouse is not impoverished by the applicant’s care needs. For 2025, sources cite a Community Spouse Resource Allowance and combined/married asset figures used in eligibility calculations (examples: asset limits, minimum/maximum income allowances) [2] [6] [3].
4. Asset and income thresholds differ by program and by whether both spouses apply
Long‑term care MaineCare has distinct asset limits: a single applicant limit around $10,000 in 2025 and combined or couple-specific figures (for couples applying together or when only one spouse applies) that change the countable resource standard. If both spouses are applicants or live in separate facilities, different per‑person limits apply; Maine’s guidance specifically treats transfers between spouses differently and allows transfers without penalty in many cases [3] [2] [7].
5. Income diversion and “deeming” rules can make one spouse’s needs eligible
Maine uses mechanisms such as deeming or “ineligible spouse” treatment: when a couple’s combined income would otherwise make them ineligible, the spouse with lower medical needs may be considered ineligible and an amount is subtracted from combined income to help the spouse with greater needs qualify. States also allow some income to be transferred to the community spouse to reach minimum living allowances [8] [2].
6. The home, transfers, look‑back and estate recovery are relevant to spouses
MaineCare’s long‑term care rules typically exclude one primary residence under specified equity limits and allow transfers of the home to a spouse or certain relatives without penalty. Medicaid look‑back rules and estate recovery requirements apply; for applicants 55 and older Maine can pursue estate recovery for benefits paid, a fact that matters for married applicants and survivors [9] [10] [2].
7. Numbers to watch and where they come from
Practitioner and advocacy sites cited here list concrete 2025 figures used in spousal calculations: $10,000 single asset limit, combined couple figures near $15,000 for certain long‑term care categories, and a Community Spouse Resource Allowance cited at about $157,920 in 2025 — all figures come from long‑term care planning and elder‑law sources summarizing Maine rules [3] [6] [2].
8. Competing perspectives and limits in the sources
State DHHS/OFI pages present program structure and direct guidance (application processes and that household/tax relationships matter) but often leave numerical details and interpretation to manuals and practitioner summaries; elder‑law and planning sites provide detailed dollar figures and planning advice but are not official policy texts and sometimes paraphrase or interpret rules for clients. Readers should treat official MaineCare manuals and OFI notices as authoritative while using elder‑law guides to understand practical implications [11] [12] [6].
9. What reporting here does not say (limits of available sources)
Available sources do not provide a single, consolidated statutory text in these search results that lists every formula used to compute the community spouse allowance or every step of the deeming calculation. For final, case‑specific numbers and to resolve contradictions, applicants should consult the MaineCare Benefits Manual, OFI caseworkers, or certified elder‑law counsel [12] [11].
If you want, I can pull the specific MaineCare Benefit Manual rules and the official OFI guidance pages referenced above and summarize the precise formulas that apply when one spouse enters a nursing facility.