In Georgia Medicaid, a nursing-facility resident keeps just $70 a month and pays almost all of their remaining income toward their cost of care. That contribution is called patient liability: the share of a resident's monthly income applied to care once Medicaid covers a nursing facility or waiver, after a fixed set of deductions. It also goes by cost-of-care contribution, share-of-cost, applied income, or post-eligibility treatment of income. This guide shows exactly how Georgia calculates it, walks the deductions that lower it, and works the dollar math for five real situations.

In This Guide

What patient liability and cost of care mean for Georgia families

When a parent enters a nursing facility or starts an HCBS waiver, families often expect Medicaid to "pay for everything." It does not work that way. Medicaid pays the cost of care, but the beneficiary contributes their own available monthly income toward that cost, after a fixed set of protective deductions. That contribution is patient liability.

The deductions decide the answers families actually want: how much income the resident keeps for personal use, how much is protected for a spouse still at home, how much can be set aside to maintain the house, and how much offsets medical bills Medicaid does not cover. Get the deductions right and the patient-liability number is fair. Get them wrong and a family overpays the facility every month.

The rest of this guide explains the federal post-eligibility framework, how Georgia's Department of Community Health (DCH) applies it, what each deduction covers, and how to check the agency's math.

The federal framework Georgia follows

Georgia does not invent its own cost-of-care rules. It applies the federal post-eligibility treatment of income (PETI) framework, which sets the deductions and their order.

  • The post-eligibility rules require a Medicaid beneficiary in institutional care to apply their available income to the cost of care after the allowed deductions; 42 CFR 435.725 is where those deductions and their federal minimums are written.
  • Section 1902(q) of the Social Security Act (42 U.S.C. 1396a(q)(2)) sets a federal minimum personal needs allowance of $30 per month for an aged, blind, or disabled individual in a nursing facility, and $60 for an institutionalized couple if both are aged, blind, or disabled. Those are floors, not caps: a state must set its nursing-facility PNA at or above $30 and may set it higher, and Georgia sets it at $70.,
  • Section 1924 of the Social Security Act (the spousal impoverishment provisions) protects a community spouse's income through the MMMNA and protects dependents through a family allowance.
  • 42 CFR 435.725 establishes the institutional PETI deduction order; 42 CFR 435.726 applies a parallel framework to HCBS waiver members living in the community.

Under 42 CFR 435.725(c), the required deductions come off monthly income in this order: (1) personal needs allowance, (2) spouse allowance, (3) the family-maintenance deduction at § 435.725(c)(3) for an individual with a family at home, (4) incurred medical expense deduction. The home-maintenance allowance at § 435.725(d) sits outside that required list as a deduction a state may choose to add. Whatever income remains after all of them is the patient liability the resident pays the facility.

Personal needs allowance in Georgia

Georgia's nursing-facility personal needs allowance is $70 per month in 2026. This is the income the resident keeps for personal expenses Medicaid does not cover, exempt from the cost-of-care contribution. Georgia's own financial-limits chart shows the $70 rate as effective 7-19, in place since July 2019 and carried unchanged into the 2026 edition; it is more than twice the federal floor of $30. A separate $90 PNA applies to a VA pensioner or surviving spouse in a nursing home who has no dependents, and it is not a bonus: for those residents the VA check itself is reduced to the amount of the PNA regardless of other income. A VA pensioner or surviving spouse who has dependents gets the same $70.,

The PNA is meant to cover items the facility and Medicaid do not: clothing, personal hygiene beyond what the facility supplies, haircuts, a telephone or cable bill, reading materials, snacks, religious items, and small gifts. At $70 a month, roughly $2.30 a day, that does not stretch far. A single basic haircut can take a quarter of a month's allowance, and a new wardrobe means saving for several months. The rate has not moved since 2019, so every year of price increases since has come out of the same $70.

Spousal income allocation (MMMNA)

When one spouse is institutionalized (or on an HCBS waiver at a nursing-facility level of care) and the other stays in the community, Section 1924 keeps the community spouse from being impoverished. It does this two ways: a resource (asset) protection called the community spouse resource allowance, covered in the spousal impoverishment guide, and an income protection called the monthly maintenance needs allowance (MMMNA), covered here.

For 2026, the MMMNA floor is $2,705.00 per month effective July 1, 2026 (150 percent of the federal poverty level for a household of two) and the ceiling is $4,066.50 per month. The actual figure sits between the floor and the ceiling, raised by the community spouse's documented shelter costs.

How the excess-shelter bump works

  1. Start with the standard shelter allowance: 30 percent of the MMMNA floor, which is $811.50 per month effective July 1, 2026.
  2. Add up the community spouse's documented shelter costs: rent or mortgage, property tax, homeowner's insurance, utilities (electric, gas, water, basic phone), and condominium or lot fees.
  3. Subtract the standard shelter allowance from those costs to get the excess shelter amount.
  4. Add the excess shelter to the floor, up to the ceiling. That is the MMMNA.

How income is then allocated

Once the MMMNA is set, the community spouse first uses their own income. If their income is below the MMMNA, income is allocated from the institutionalized spouse to fill the gap. That allocated income counts as the community spouse's, not as patient liability. The institutionalized spouse's income, after the allocation and the other deductions, is what is left as patient liability.

Dependent allowance

The framework also protects dependents.

  • Family allowance (community spouse present). Under Section 1924 (42 U.S.C. 1396r-5(d)(1)(C)), each dependent living with the community spouse generates an additional allowance of at least one third of the amount by which the minimum monthly maintenance needs allowance exceeds that dependent's own monthly income. At the 2026 floor of $2,705.00, a dependent with no income of their own generates at least about $901.67. That one third is a statutory minimum, not a cap. Eligible family members are minor or dependent children, dependent parents, or dependent siblings of either spouse who live with the community spouse.
  • Family-maintenance deduction (no community spouse). Under 42 CFR 435.725(c)(3), an institutionalized individual with a family at home gets a family-maintenance deduction, set against a Georgia standard for a family of that size and reduced by the dependent's own income. Ask your DFCS worker which standard she applied.
  • How Georgia runs it. Georgia's DFCS manual handles the dependent side as diversion of income (PAMMS Medicaid policy 2554, effective June 2025): the income of a recipient in a nursing home, institutionalized hospice, EDWP/CCSP, NOW/COMP, or ICWP may be diverted to a spouse and/or child(ren) at home to meet their needs. For a financially dependent family member who lives with the community spouse, Georgia applies the Dependent Family Member Maintenance Need Standard (DFMNS), $2,706.00 per month effective April 2026, up from $2,645.00 the year before. Georgia counts a dependent as someone claimed on the most recent IRS tax return: a minor or dependent child, a dependent parent, or a dependent sibling of the recipient or the community spouse.

Home maintenance deduction

This is the deduction families ask about most, and it is the one Georgia is least likely to give you.

The federal rule, 42 CFR 435.725(d), lets a state allow single individuals and couples an amount, in addition to the personal needs allowance, for maintenance of the individual's or couple's home. It carries two hard limits written into the rule itself: the amount is deducted for not more than a six-month period, and only if a physician has certified that the individual is likely to return to the home within that period.

The rule is an option, not a mandate, and Georgia has not written it into its manual. The deduction list the Division of Family and Children Services applies to patient liability and cost share (PAMMS Medicaid policy 2552) does not include a home-maintenance deduction. So do not budget around one. If a facility admissions coordinator or an online calculator tells you Georgia will let you set aside the mortgage, the property tax, the insurance, and the utilities while your parent is in the facility, ask your DFCS eligibility worker to show you the policy in writing before you plan a household budget on it.

Any home-maintenance allowance is a separate thing from the home being an exempt asset, and confusing the two is where families lose money. The house can stay exempt for eligibility purposes (when the resident intends to return, or a spouse or dependent lives there) whether or not any income deduction is available. The exemption protects the asset. A maintenance allowance, in a state that offers one, protects income, and for at most six months.

Incurred medical expense (IME) deduction

Under 42 CFR 435.725(c)(4), a resident can deduct medical and remedial expenses Medicaid does not cover. The IME deduction reduces patient liability dollar for dollar: every dollar of documented uncovered medical cost is a dollar less paid to the facility.

Eligible IMEs include:

  • Insurance premiums: the Medicare Part B premium ($202.90 standard for 2026), Medicare Part D and Medicare Supplement (Medigap) premiums, and other health-insurance premiums.
  • Uncovered services: dental and vision care beyond Medicaid coverage, hearing aids, eyeglasses, specialty medications not on the Medicaid preferred drug list after exceptions are exhausted, and physician-ordered over-the-counter medications.
  • Out-of-pocket costs: copays, coinsurance, and deductibles.

To get the deduction, the resident or family must document the expense with receipts, bills, or premium statements and submit them to DCH or the Division of Family and Children Services (DFCS); the deduction is not automatic.

One trap to know: if the resident is in a Medicare Savings Program such as the Qualified Medicare Beneficiary (QMB) program, Medicaid pays the Medicare Part B premium directly. In that case the resident is no longer paying the premium, so there is no IME to deduct for it. Enrolling in QMB does not change patient liability through the premium; it simply moves who pays it. QMB does more than that, but within a defined boundary: federal law bars providers from billing a QMB enrollee for Medicare Part A and Part B cost sharing, including deductibles, coinsurance, and copayments, even when Medicaid pays nothing toward it. Cost sharing outside Parts A and B, such as Part D drug copays, is not covered by that protection.

HCBS waiver patient liability

For members on a Section 1915(c) HCBS waiver, 42 CFR 435.726 applies a parallel framework adapted to community living. Read its scope before you assume it applies to you: by its own terms the section covers waiver members who are eligible under 42 CFR 435.217, the special income level group, which in Georgia is Waiver Medicaid / Medical Assistance Only at up to 300 percent of the SSI federal benefit rate, $2,982 a month in 2026. A member who qualified instead through the SSI pathway, with income under the $994 federal benefit rate, is on a different eligibility basis, so ask DFCS whether any cost share applies before you budget for one.,

The main differences:

  • Maintenance needs allowance instead of the institutional PNA. The $70 figure is the nursing-facility and institutionalized-hospice PNA. A waiver member living at home still pays rent or a mortgage and utilities, so the cost-share budget protects a community-living maintenance needs allowance in its place. Ask DFCS for the amount it applied in your budget, since it is not the $70 institutional figure.
  • Spouse allowance applies the same way under Section 1924 when the member meets a nursing-facility level of care.
  • The IME deduction applies the same way.
  • No home-maintenance allowance is in play, since the member already lives at home and housing costs run through the maintenance needs allowance.

Georgia operates four active 1915(c) HCBS waivers: the Elderly and Disabled Waiver Program (EDWP) for frail elderly and disabled adults, which delivers services through two models rather than two waivers, the Community Care Services Program (CCSP) and Service Options Using Resources in a Community Environment (SOURCE); the Independent Care Waiver Program (ICWP) for adults who apply between the ages of 21 and 64 with severe physical disabilities; and the New Options Waiver (NOW) and Comprehensive Supports Waiver (COMP) for people with intellectual and developmental disabilities. For many waiver members with modest income, the maintenance needs allowance plus any spousal allocation and IME deduction leaves zero or minimal patient liability.

Worked examples

The people below are illustrative, not real cases, and the income amounts are hypothetical. Each example walks the deduction stack in order using the 2026 policy figures (the $70 PNA, the $202.90 Medicare Part B premium, and the MMMNA floor and shelter standard) so you can see how a real notice should add up.,,

Eleanor, age 82, Atlanta nursing facility, no spouse

Eleanor is widowed with no dependents and sold her home before applying, so there is no spouse or dependent deduction. Her income is $2,220 a month (Social Security $1,820 plus a $400 pension). Her uncovered medical costs are the Medicare Part B premium ($202.90), a Medigap Plan G premium ($150), and dental copays (about $20), for $372.90 in IME.

Step Amount
Gross monthly income $2,220.00
Less personal needs allowance $70.00
Less spouse allowance $0.00
Less dependent allowance $0.00
Less incurred medical expense $372.90
Patient liability $1,777.10

Eleanor pays $1,777.10 a month to the facility and keeps $70 for personal needs. The facility bills Medicaid for the rest of the cost of care. If Eleanor enrolled in QMB, Medicaid would pay her Part B premium, but that would also drop her IME by $202.90, leaving her patient liability essentially unchanged.

Walter and Margaret, age 78, with a community spouse

Walter is in a nursing facility; Margaret, 76, remains in their home of 35 years. Walter's income is $2,700 a month; Margaret's is $1,100. Margaret's documented shelter costs total $1,375 (mortgage $850, property tax $200, insurance $75, utilities $250).

MMMNA: floor $2,705.00, standard shelter allowance $811.50, so excess shelter is $1,375 − $811.50 = $563.50. MMMNA = $2,705.00 + $563.50 = $3,268.50, below the $4,066.50 ceiling. Margaret has $1,100, so the allocation from Walter is $3,268.50 − $1,100 = $2,168.50. Walter's IME is the Part B premium of $202.90.

Step Amount
Gross monthly income $2,700.00
Less personal needs allowance $70.00
Less spouse allowance (MMMNA allocation) $2,168.50
Less incurred medical expense (Medicare Part B) $202.90
Patient liability $258.60

Walter pays $258.60 a month. Margaret receives $2,168.50 from his income plus her own $1,100, for $3,268.50 to run the household.

George, age 76, with a dependent adult daughter

George is unmarried. His daughter Lisa, 35, has cerebral palsy, lives in his home, and receives $994 a month in Supplemental Security Income (SSI). George's income is $2,500 a month.

Because George has no community spouse, the family-maintenance deduction uses the Georgia state-plan standard minus Lisa's income. Lisa's $994 SSI exceeds that standard, so the deduction comes out to $0. Georgia's deduction list carries nothing for keeping up the house Lisa lives in, so no home-maintenance amount enters the math either. His IME is the Part B premium ($202.90) plus prescription copays ($25), or $227.90.

Step Amount
Gross monthly income $2,500.00
Less personal needs allowance $70.00
Less spouse allowance $0.00
Less dependent allowance $0.00
Less incurred medical expense $227.90
Patient liability $2,202.10

George pays $2,202.10 a month. This is the case that surprises families: a dependent with her own SSI check produces no allowance, and the mortgage and utilities on the house Lisa still lives in have to come from somewhere other than George's income. Ask the eligibility worker to confirm the dependent standard she used and how she counted Lisa's income before accepting the number.

Doris, age 70, HCBS waiver with a community spouse

Doris is on Georgia's EDWP waiver, under its CCSP model, at a nursing-facility level of care. She and her husband Robert, 72, live together. Doris's income is $1,600 a month; Robert's is $1,800. Robert's documented shelter costs are $1,400.

MMMNA: floor $2,705.00, standard shelter allowance $811.50, excess shelter $1,400 − $811.50 = $588.50, so MMMNA = $3,293.50 (below the ceiling). Robert has $1,800, so the allocation from Doris is $3,293.50 − $1,800 = $1,493.50. Doris's IME is the Part B premium of $202.90.

Step Amount
Gross monthly income $1,600.00
Less HCBS maintenance needs allowance (community-living amount)
Less spouse allowance (MMMNA allocation) $1,493.50
Less incurred medical expense $202.90
Patient liability likely $0 or minimal

Under the HCBS framework, Doris's community-living maintenance needs allowance, plus the spousal allocation and IME, usually leaves zero or minimal patient liability, because her income is already accounted for in supporting the household.

Frances, age 85, high IME from prescription costs

Frances has been in a facility 18 months and is widowed. Her income is $1,400 a month. She takes a specialty drug not on the Medicaid preferred drug list, and after formulary exceptions are exhausted she pays $400 a month out of pocket. Her IME totals $882.90: the specialty drug ($400), Part B premium ($202.90), Part D premium ($35), Medigap Plan F ($180), hearing-aid supplies ($25), and dental copays ($40).

Step Amount
Gross monthly income $1,400.00
Less personal needs allowance $70.00
Less incurred medical expense $882.90
Patient liability $447.10

Frances pays $447.10 a month. The large IME deduction is doing its protective job: it keeps uncovered medical costs from impoverishing her.

Common misconceptions

"Medicaid pays the whole nursing home bill." No. Medicaid pays the cost of care minus your patient liability; your income, after deductions, covers the rest.

"The community spouse only gets what the institutionalized spouse gives them." No. Section 1924 is a legal entitlement; the MMMNA is calculated by the agency and is appealable.

"$70 a month is enough for personal needs." Judge it against the arithmetic: $70 is about $2.30 a day to cover clothing, hygiene items the facility does not supply, haircuts, a phone bill, and small gifts, and the rate has not changed since 2019.

"Patient liability is the same as estate recovery." No. Patient liability is a monthly contribution from income while the beneficiary is alive. Estate recovery is post-death recovery from the estate.

"If the beneficiary has no income, there is patient liability anyway." No. Patient liability is carved out of the resident's own income, so a resident whose countable income is at or below the $70 personal needs allowance has nothing left to apply and owes $0. Note the flip side: income above the PNA does produce a liability, whatever its source, so do not assume a modest Social Security or SSI check means nothing is owed.

"Georgia will let me deduct the mortgage while Mom is in the facility." Not on the strength of the policy manual. The federal home-maintenance allowance at 42 CFR 435.725(d) is a state option, limited to six months and to residents a physician certifies are likely to return home, and Georgia's DFCS deduction list does not include it. The home can still stay an exempt asset.

"IME deductions are automatic." No. You must document and submit them, or you lose them.

How to check and appeal your cost of care calculation

Patient-liability math is easy to get wrong, and the family is often the only one checking. Walk through the agency's notice and confirm each step: all income is identified, the $70 PNA is applied, the spousal allocation reflects the current MMMNA and the community spouse's income, any dependent allowance or diversion is included, and every documented IME is deducted.

If something is off, request a correction from the eligibility worker first. If that does not resolve it, file a state fair-hearing request with the agency that issued the notice. Federal rule 42 CFR 431.221(d) caps a state's request window at 90 days from the date the notice is mailed, but that 90 days is a ceiling on the state, not a period you are guaranteed: Georgia DFCS policy directs that a hearing on an eligibility decision be requested within 30 days of the notice, so treat 30 days as your deadline and read the date printed on your own notice of action. The hearing itself is conducted by the Georgia Office of State Administrative Hearings (OSAH), the separate tribunal state agencies transmit hearing requests to, and you may bring a family member or attorney. To document income, gather Social Security and pension statements, annuity records, and bank statements; to document IME, keep Medicare and Medigap premium statements, pharmacy receipts, and dental, vision, and hearing bills.

Georgia Department of Community Health (DCH) Runs Georgia Medicaid; Member Services answers eligibility and patient-liability questions. 1-866-211-0950https://www.gabar.org/about-the-bar/contact-us dch.georgia.gov
Georgia Long-Term Care Ombudsman Advocates for residents of nursing homes, personal care homes, and assisted living, and investigates complaints. Run by the Division of Aging Services. aging.georgia.gov/programs-and-services/long-term-care-ombudsman-program
Georgia Legal Services Program Free civil legal help, including fair-hearing representation, for qualifying lower-income Georgians. 404-377-0701 www.glsp.org

FAQ

What is patient liability in Georgia Medicaid?

Patient liability is the share of a beneficiary's monthly income that goes toward their cost of care once Georgia Medicaid covers nursing-facility or Section 1915(c) HCBS waiver services. It is also called post-eligibility treatment of income (PETI), cost-of-care contribution, share-of-cost, or applied income. The federal rules are at 42 CFR 435.725 (institutional) and 42 CFR 435.726 (HCBS).

What is the personal needs allowance in Georgia?

Georgia's nursing-facility personal needs allowance is $70 per month in 2026, shown on Georgia's financial-limits chart as effective 7-19 and unchanged since. It is the income the resident keeps for personal expenses Medicaid does not cover, more than twice the $30 federal minimum. A $90 PNA applies to a VA pensioner or surviving spouse in a nursing home with no dependents, and for those residents the VA check is reduced to the amount of the PNA regardless of other income; one who has dependents gets the same $70.,

What is the monthly maintenance needs allowance (MMMNA)?

The MMMNA is the income a community spouse may keep under Section 1924 of the Social Security Act. For 2026, the floor is $2,705.00 per month effective July 1, 2026 (150 percent of the federal poverty level for a household of two) and the ceiling is $4,066.50 per month. The actual figure is set between them based on the community spouse's documented shelter costs.

How is the spouse allowance calculated?

Determine the MMMNA, then allocate income from the institutionalized spouse up to the amount that brings the community spouse's income to the MMMNA. If the MMMNA is $3,000 and the community spouse has $1,200, then $1,800 is allocated. That allocated income counts as the spouse's, not as patient liability.

What is the family allowance for dependents?

Under Section 1924 (42 U.S.C. 1396r-5(d)(1)(C)), each dependent living with the community spouse generates an allowance of at least one third of the amount by which the minimum monthly maintenance needs allowance exceeds that dependent's own income. At the 2026 floor of $2,705.00, that is at least about $901.67 for a dependent with no income, and the one third is a statutory minimum rather than a cap. Eligible family members are minor or dependent children, dependent parents, or dependent siblings of either spouse. Georgia applies this as diversion of income under DFCS PAMMS Medicaid policy 2554, using the Dependent Family Member Maintenance Need Standard of $2,706.00 per month, effective April 2026, for a financially dependent family member who lives with the community spouse.

What is the home maintenance deduction?

Under 42 CFR 435.725(d), a state may allow a nursing-facility resident an amount, in addition to the personal needs allowance, for maintenance of the resident's or couple's home. The rule deducts it for not more than a six-month period, and only if a physician has certified the resident is likely to return home within that period. It is a state option rather than a requirement, and Georgia's DFCS patient-liability deduction list (PAMMS Medicaid policy 2552) does not include a home-maintenance deduction, so ask your eligibility worker before assuming one.

What is the incurred medical expense (IME) deduction?

Under 42 CFR 435.725(c)(4), a resident may deduct medical and remedial expenses Medicaid does not cover, including the Medicare Part B premium ($202.90 standard in 2026), Medigap and other premiums, uncovered dental, vision, and hearing care, and physician-ordered over-the-counter medications. Documentation is required.

How is HCBS waiver patient liability different?

Under 42 CFR 435.726, waiver members keep a community-living maintenance needs allowance instead of the $70 institutional PNA, which is the nursing-facility and institutionalized-hospice figure. That section is scoped to members eligible under 42 CFR 435.217, the special income level group, which in Georgia means Waiver Medicaid / Medical Assistance Only at up to 300 percent of the SSI federal benefit rate, $2,982 a month in 2026; a member on the SSI pathway instead should ask whether any cost share applies. The spouse allowance and IME deduction apply the same way, and many waiver members have zero or minimal patient liability. Ask DFCS which maintenance needs amount it used in your cost-share budget.

What if the beneficiary has no income?

A beneficiary whose countable income is at or below the $70 personal needs allowance has nothing left to apply after the deductions, so patient liability is $0. Above that, the resident pays what remains after the PNA, any spouse or dependent allowance, and documented incurred medical expenses. A resident's SSI payment can itself change once Medicaid is paying for facility care, so ask DFCS to walk you through the income figure it used.

Can I challenge my patient liability calculation?

Yes. Ask the eligibility worker for a correction first. If that fails, file a state fair-hearing request with the agency that issued the notice. Georgia DFCS policy directs that a hearing on an eligibility decision be requested within 30 days of the notice; federal rule 42 CFR 431.221(d) caps a state's window at 90 days from the mailing date, but that is a ceiling on the state rather than a period you are guaranteed, so go by the date on your own notice. The hearing is conducted by the Office of State Administrative Hearings, and you may bring a family member or attorney. The Georgia Legal Services Program offers free help to qualifying low-income beneficiaries.

When does patient liability change?

It is recalculated when income changes (a Social Security cost-of-living adjustment, a pension change), when IME changes, when spouse circumstances change (death, divorce, an income change), when a dependent's circumstances or income change, and at the annual eligibility redetermination.

Learn More

Your next step Not sure your patient-liability notice adds up? Request the DCH worksheet from your DFCS eligibility worker at 1-877-423-4746, walk each deduction in order against this guide, and if a number is wrong, ask for a correction or file a fair-hearing request by the deadline printed on your notice, which Georgia policy sets at 30 days.

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.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.