California Medi-Cal Personal Needs Allowance (2026)

California gives a nursing-home resident on Medi-Cal just $35 a month to keep for personal spending. Those are the dollars the resident keeps in hand for items the facility does not provide, and they are called the Personal Needs Allowance, or PNA.

California's institutional PNA is not the whole story. It is really two separate figures set by two separate programs: $35 a month for institutional nursing-facility residents who qualify through the Medically Needy / Share-of-Cost pathway, and $62 a month for Supplemental Security Income (SSI) recipients in a nursing facility, which is the reduced benefit the Social Security Administration pays in a Medicaid-funded facility plus California's own state supplement. Residents in California's Assisted Living Waiver are in a different position again: that waiver pays for care but not for room and board, so the resident pays room and board out of their own income and keeps what is left. There is no $35 institutional allowance in a community-based case.

This guide walks through each figure, the Share-of-Cost math that routes a resident's income to the facility, the 2026 changes, and the pitfalls families hit once they see how little a resident keeps.

What the California Personal Needs Allowance Is and Why It Exists

The Personal Needs Allowance exists because federal Medicaid law recognizes a basic principle: a person who lives in a nursing facility and has had nearly all their income redirected to pay for care should still have a small amount each month for the things the facility does NOT provide. A haircut, a phone call to a grandchild, a birthday card, a pair of socks. These small expenses are what let a person remain a person rather than a patient.

Federal law sets a floor, and it is a floor with a defined population: at least $30 a month for an aged, blind, or disabled institutionalized individual, and at least $60 a month for an institutionalized couple where both spouses are aged, blind, or disabled. For anyone outside those groups the federal rule leaves "a reasonable amount set by the agency", so $30 is not a single universal federal figure. States may set their PNA above the floor. Texas sets it at $75.2,3 California sets its institutional PNA at $35, fixed in California regulation (22 CCR § 50605(a)(1)) and unchanged for years.1 A haircut, a phone bill, and a newspaper subscription each cost more than a few dollars, so $35 covers roughly one of them a month, and not very well.

Elder-care advocates and the state's elder-law bar consider the figure inadequate, and groups including California Health Advocates and CANHR have pressed to raise it, without an enacted increase so far.

The figure has stayed static for a straightforward reason: cost. Each dollar not designated as PNA offsets Medi-Cal's cost of care, and the affected population is small and largely unable to advocate for itself.

How Much a California Resident Keeps, by Program

California's PNA is not one number. Different programs, with different income sources and different administering authorities, deliver different amounts.

Institutional Medi-Cal: $35 a month

The Medically Needy / Share-of-Cost institutional Medi-Cal PNA is $35 a month. The regulation attaches a condition worth knowing: the $35 maintenance need applies when the beneficiary will remain in long-term care for the entire calendar month.1

The resident keeps that $35 and the remainder of their countable income goes toward the monthly Share-of-Cost, paid directly to the facility; Medi-Cal pays the difference between the facility's rate and that amount.5 Medicare and other premiums, a community-spouse allowance, and a family allowance are deducted as well, as the next section walks through.

SSI recipients in nursing facilities: $62 a month

A nursing-facility resident who is also an SSI recipient is on a different track and does NOT receive the $35 institutional Medi-Cal PNA. They keep a separate $62 a month, California's SSI/SSP payment standard for an individual in a Title XIX medical facility, effective January 1, 2026 ($124.00 for a couple).1

The mechanic starts federal. Where an SSI recipient is in a medical facility, Medicaid pays more than half the cost of care, and the stay covers a whole calendar month, SSA limits the federal SSI benefit to $30 a month plus any supplementary state payment. California's SSP supplement brings that to the $62.00 Title XIX Medical Facility standard. An SSI resident keeps the $62, not both figures.1

Assisted Living Waiver residents

The mechanic under California's Assisted Living Waiver is fundamentally different. The ALW is open to people aged 21 and over at nursing-facility level of care, and pays for care in a Residential Care Facility for the Elderly, an Adult Residential Facility, or subsidized public housing. What it does not pay for is room and board, which the resident covers from their own funds, keeping the remainder.4

Two limits matter before a family plans around it. First, there is no $35 institutional personal needs allowance in a community case; the arithmetic is room and board out of the resident's own income, not a fixed protected amount.5 Second, the ALW runs in only 15 counties (Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, Sonoma) and carries a large waitlist.4

What the California PNA Can Be Spent On

The PNA is the resident's money, $35 or $62 a month depending on their program.1 Federal nursing-facility rules give a resident the right to manage their own financial affairs, so the resident, or their representative payee, decides how to spend it.7 Common allowable categories:

• Personal-care items beyond the facility baseline: preferred-brand toothpaste, soap, shampoo, deodorant, razors, denture cleaner, hearing-aid batteries.
• Communication: a cellphone bill, prepaid phone cards, postage, greeting cards, internet access if not facility-provided.
• Clothing replacement: undergarments, socks, slippers, outerwear, and items lost in facility laundry.
• Entertainment: a newspaper or magazine subscription, books, streaming subscriptions, puzzle books, crafting supplies.
• Social and comfort spending: gifts for grandchildren, holiday cards, modest charitable donations, barber or beauty-parlor services beyond the facility baseline, manicures, footcare, and legal tobacco.

What the PNA Cannot Be Spent On

The PNA is for personal expenses. Federal rules put a specific list of routine items and services inside the facility's per-diem rate, and during a covered stay the facility must not charge the resident for them, which also means they may not be billed to the resident's personal funds:8

• Nursing services and food and nutrition services (three meals a day plus snacks).
• An activities program.
• Room and bed maintenance.
• Routine personal hygiene items and services: hair hygiene supplies, comb, brush, bath soap, razor, shaving cream, toothbrush, toothpaste, denture adhesive and cleaner, moisturizing lotion, incontinence care and supplies, towels, washcloths, over-the-counter drugs, hair and nail hygiene services, and bathing assistance.
• Basic personal laundry (preferred dry-cleaning falls to the PNA).

Some facilities stock only generic minimum-quality versions of the covered hygiene items, which is why preferred brands fall to the PNA. What a facility cannot do is bill the resident's personal funds for the covered baseline itself.8

How the Share-of-Cost Calculation Works

California's patient-pay calculation, Share-of-Cost, subtracts allowable deductions from the resident's gross monthly income. The ones that matter most:

• Personal Needs Allowance. $35 a month (institutional) or $62 a month (SSI resident in a facility, through the SSA mechanic above).1
• Community-spouse maintenance-needs allowance. California publishes a single Minimum Monthly Maintenance Needs Allowance of $4,067 a month effective January 1, 2026 (DHCS ACWDL 26-02 rounds the federal maximum of $4,066.50 to the whole dollar; the 2025 California figure was $3,948). DHCS does not publish a separate California floor, so do not expect a lower "minimum" number from your county. When the community spouse's gross income is measured against that figure, amounts she or he pays for Medicare and other health-insurance premiums are deducted.5
• Family allowance. A dependent-family-member allowance is available in addition to the community spouse's allowance, but it is bounded: it reaches minor or dependent children, dependent parents, or dependent siblings of either spouse who reside with the community spouse, and for each such person it equals at least one third of the amount by which the maintenance-needs standard exceeds that person's own monthly income.9
• Medicare and other health-insurance premiums. Part B is $202.90 a month standard for 2026, plus IRMAA if it applies, along with Part D, Medigap, and other coverage the resident pays for.10

The exact list of post-eligibility deductions, and the order a county applies them in, comes from the federal rule at 42 CFR § 435.725 and the county's own instructions. Read the deductions actually applied off the resident's Notice of Action, and ask the eligibility worker about anything missing.

The remainder is the resident's Share-of-Cost, paid directly to the facility each month, and Medi-Cal pays the difference between the facility's rate and that amount. The facility receives the same total either way; the formula only determines who pays what.5

The structural point for a family: income above what the resident is allowed to keep does not make them ineligible. W&I Code § 14005.13(a) addresses exactly the case of a long-term-care resident whose income exceeds what is allowed for incidental and personal needs, and treats it as long-term-care patient liability, meaning a share of cost.6 If someone tells you a California nursing-home applicant is "over the income limit," ask your county eligibility worker to show you the rule.

Worked Example: Eleanor, a Single Nursing-Facility Resident

The following is illustrative; the individual and the income figures are hypothetical. Eleanor is 79, lives in Oakland, and entered a Medi-Cal-certified nursing facility in February 2026 after a fall. She will remain in long-term care for the entire calendar month, the condition the regulation sets for the $35 maintenance need, and her Social Security plus a small teacher's pension exceeds SSI thresholds, so the $35 institutional PNA applies rather than the $62 SSI figure.1

Eleanor keeps $35 a month for personal expenses. She receives no community-spouse deduction because she is single.1 In practice, that $35 covers a basic cellphone plan to call her two sons and a newspaper subscription, with a few dollars rolling forward each month into her account.

By month four her son notices the balance climbing on a quarterly statement, and asks whether it matters. It can: under AB 116's reinstated asset test, Eleanor's countable resources cannot exceed $130,000, and that balance counts.6 A few hundred dollars is far from the cap, but a resident who banked PNA across years, particularly during the 2024 to 2025 window when no asset test applied, should use or spend it down.

Worked Example: Frank, a Married Nursing-Facility Resident

This second example is also illustrative, with hypothetical figures. Frank is 81, lives in Sacramento, and entered a nursing facility in March 2026 after a stroke. He will be in long-term care for the entire calendar month and his income is well above SSI levels, so the $35 maintenance need applies rather than the $62 SSI figure. His wife Hilda lives in their home in the community with her own Social Security income.1

Because Hilda is a community spouse, part of Frank's income is deflected to her under California's Minimum Monthly Maintenance Needs Allowance, which DHCS sets at $4,067 a month effective January 1, 2026.5 Hilda's own income is counted first, and the allowance transfers the difference from Frank's income up to that level. Her own Social Security is $2,277 a month, so $1,790 of Frank's income goes to her and his income available for the Share-of-Cost drops by that amount.

The allocation and the PNA are separate line items: Frank does not lose his $35 when income flows to Hilda, he keeps both. California extends spousal-impoverishment protection beyond institutional care to its home- and community-based services, under the ACA's broadened definition of an institutionalized spouse as implemented by DHCS letters ACWDL 17-25 and 18-19, so Hilda would be protected if Frank were on an HCBS waiver instead. Note the trade-off: in an HCBS case there is no $35 personal needs allowance.5

How the $35 Has Held for Years

California's institutional PNA has stayed at $35 a month for years, fixed in California regulation.1 The state's Medi-Cal policy attention has gone elsewhere, to the 2024 to 2025 asset-test elimination and its 2026 reinstatement under AB 116.6 Advocacy groups including Justice in Aging press for an increase, without an enacted change so far.

The 2026 Changes That Affect Your PNA

Two 2026 changes matter for managing a resident's PNA and Share-of-Cost:

• The asset test is back. AB 116 reinstated the Medi-Cal asset test on January 1, 2026 at $130,000 for an individual and $195,000 for a couple, and banked PNA counts toward it. Transfers made between January 1, 2024 and December 31, 2025 are not reviewed in the look-back period, because the asset test did not apply during those months.6
• The look-back is phasing in. California's look-back period is 30 months, shorter than the federal 60-month look-back that applies to assets disposed of on or after February 8, 2006. Beginning July 1, 2026, the number of look-back months reviewed increases by one each month until the full 30-month review applies to long-term-care applications on or after July 1, 2028, and the maximum period of ineligibility is 30 months from the date of the transfer.5 That penalty is a nursing-facility-level-of-care rule, which is not the same thing as a promise that a transfer carries no consequence for an HCBS waiver application; confirm any past transfer with your county eligibility worker.4

National Context

Three grounded comparison points put California's $35 in context: the federal floor is $30 a month for an aged, blind, or disabled institutionalized individual, and Texas sets its PNA at $75.2,3,1

PNA alone should not drive a move: asset limits, look-back periods, and maintenance-needs methodology all differ across states. It is a useful indicator of how a state treats residents' dignity money, not a relocation plan.

Practical Tips for Managing the California Personal Needs Allowance

1. Know which figure applies. A resident's PNA depends on their program: institutional nursing facility ($35), SSI recipient in a facility ($62 through the SSA mechanic), or the Assisted Living Waiver, where the resident pays room and board instead.1 If you are unsure, ask the facility's social worker or your county Medi-Cal eligibility worker.
2. Set up the phone first. Calling family is the single most important PNA expenditure in many residents' lives. Set up a basic prepaid or family-shared plan early.
3. Request the account statement. A facility may not require a resident to deposit personal funds with it, but if the resident lets it hold them, it must provide quarterly statements and record access on request. Ask.7
4. Coordinate family-deposited cash. Money added beyond the PNA should go into the trust-fund account or a separate account in the resident's name; cash handed to the resident may land in the trust fund by default. Coordinate with the social worker.
5. Re-check at recertification. At the annual recertification, confirm the PNA on the new Notice of Action along with the deductions the county applied. The figure rarely moves mid-year, but the program can: a move from the Assisted Living Waiver into a nursing facility puts the resident under the $35 institutional allowance.

Common Pitfalls

1. Letting PNA sit unspent. Unused PNA is foregone dignity, and under California's reinstated asset test it accumulates against the $130,000 / $195,000 limits. Help the resident actually spend it.6
2. Commingled trust funds. Federal rules require a full and separate accounting that precludes any commingling of resident funds with facility funds. If you see a "facility deposit" or "operating credit" line on a statement, report it to the Long-Term Care Ombudsman and the California Department of Public Health.7
3. Confusing the $35 and $62 figures. Only SSI recipients keep the $62. Residents whose income exceeds SSI thresholds keep $35.1
4. Family confiscation of PNA. The money belongs to the resident. Family members who systematically withdraw it for their own use may be committing financial elder abuse.
5. Paying PNA for facility-covered items. If a facility bills the resident's personal funds for something inside the per-diem rate (meals, the activities program, routine hygiene items, basic personal laundry), challenge the charge and contact the Long-Term Care Ombudsman if it refuses to refund.8
6. Confusing PNA with other benefits. SNAP, VA pension, and Aid and Attendance each have their own rules and can interact with a Medi-Cal budget. Verify the full benefit profile with the county at intake.

Where to Get Help

Learn More

Find personalized help navigating California Medi-Cal long-term care costs at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.