Georgia Medicaid Personal Needs Allowance (2026): The $70 NF PNA

In a Georgia nursing facility, Medicaid lets a resident keep just $70 a month for personal expenses, the Personal Needs Allowance (PNA), while nearly all their other income goes to the facility.1 That $70 sits above the federal floor of $30 set at 42 USC 1396a(q) in 1987 and never raised by Congress since, and it covers everything the facility does not provide.2

The PNA is not "extra" money. It is the only money a nursing facility resident on Medicaid has to spend on anything beyond what the facility provides: clothing beyond institutional supplies, preferred toiletries, snacks, telephone, hair care, magazines, transportation for outings, small gifts, and similar personal-dignity expenses. Without the PNA, a resident's entire monthly income would flow to the facility, leaving them with nothing for autonomy or quality of life.

This guide explains how the $70 PNA fits into the broader post-eligibility income calculation that converts gross income into patient liability, how it differs from the much larger maintenance allowance for HCBS waiver participants who live in the community ($2,982 per month in 2026), how Georgia uses a separate $90 PNA for a VA pensioner who has no dependents in place of the $70, the rules for the resident trust account at the facility, what the PNA can and cannot be used for, the $2,000 asset limit interaction, and what happens to the balance at death or transfer.

In This Guide

• Key Takeaways
• What the Georgia Medicaid Personal Needs Allowance Is and Where the Authority Comes From
• The $70 Georgia NF PNA in Context2
• The Post-Eligibility Income Calculation Step by Step
• HCBS Waiver Community Maintenance Allowance (300% SSI)
• The Resident Trust Account at Georgia Nursing Facilities
• What the PNA Can and Cannot Be Spent On
• The $2,000 Asset Limit Interaction
• Veterans: Georgia Uses a $90 PNA Instead of the $70
• What Happens to the PNA When a Resident Dies or Transfers
• Three Worked Examples
• Common Mistakes Families Make
• Frequently Asked Questions

What the Georgia Medicaid Personal Needs Allowance Is and Where the Authority Comes From

When an individual receives Medicaid-funded nursing facility care, the facility is paid through a combination of three streams: the federal Medical Assistance Percentage, the state share (paid by Georgia DCH from the General Fund and assessments), and the resident's own income contribution (called patient liability or share of cost). The resident does not pay rent or board separately; Medicaid pays the facility a contracted per-diem rate that covers room, board, nursing, food, basic personal care supplies, and most therapies.

Federal law requires that the resident retain a small portion of their monthly income for personal expenses before patient liability is calculated. This is the Personal Needs Allowance. It is deducted from the resident's gross income alongside other protective deductions (health insurance premiums, spousal maintenance allowance, dependent family allowance, certain medical expenses) before the remaining amount is owed to the facility.

Federal authority:

• 42 USC 1396a(q) establishes the mandatory PNA and sets the federal floor at $30 per month for nursing facility residents.2 The floor was created by the Omnibus Budget Reconciliation Act of 1987 (Public Law 100-203, Section 4211), effective July 1, 1988, and has never been indexed for inflation or raised by Congress since.
• 42 CFR 435.725 governs the post-eligibility treatment of income for institutionalized individuals, specifying the order of deductions: health insurance premiums, PNA, spousal MMMNA and CSMIA, dependent family allowance, incurred medical expenses, then patient liability.
• 42 CFR 435.726 governs the post-eligibility income calculation for HCBS waiver participants, which uses a larger maintenance allowance to allow community living.
• 42 CFR 483.10(f)(10) governs how nursing facilities must hold and account for resident funds.

State authority:

• O.C.G.A. Title 49 Chapter 4 establishes the Georgia Medicaid program
• The Georgia DCH Aged, Blind, and Disabled (ABD) Medicaid Policy Manual contains the operational PNA and post-eligibility rules
• Rules of Georgia Department of Community Health 111-3-8 (NF licensure) incorporate the federal resident funds requirements with state-specific reporting

States may set their PNA above the federal floor. Georgia's $70 is approximately 2.3 times the federal minimum.1,2

The $70 Georgia NF PNA in Context

Georgia's $70 sits well above the $30 federal floor, the least any state is permitted to protect for an institutionalized individual. Each state sets its own figure at or above that floor, so a Georgia number should never be assumed to hold in another state.2

The PNA has historically lagged inflation badly. The federal floor has remained at $30 since 1988, so its real purchasing power has eroded substantially over nearly four decades of inflation. Even the Georgia $70 PNA represents meaningfully less purchasing power today than $30 did in 1988.2

For families, the practical implication is that the PNA is sufficient for very modest personal expenses (telephone, small clothing and toiletry items beyond what the facility provides, hair care, occasional outings) but not for substantial discretionary spending. Families often supplement the PNA from outside funds, which is permitted as long as the supplementary funds are not pooled into the resident trust account in ways that affect Medicaid asset accounting.

Practical PNA categories in dollar terms:

In practice, $70 per month requires careful budgeting.1 Many residents prioritize telephone, hair care, and snacks; clothing and other items are often supplemented by family.

The Post-Eligibility Income Calculation Step by Step

This is the most operationally important part of the PNA framework. The post-eligibility calculation at 42 CFR 435.725 converts a Medicaid nursing facility resident's gross monthly income into the patient liability owed to the facility, with the PNA and other protective deductions taken first.

Order of deductions (mandatory federal sequence):

Worked illustration. A single, widowed Georgia NF resident with $1,500 per month in Social Security and no other income:2

• Gross income: $1,500
• Minus Part B premium ($202.90): $1,297.106
• Minus PNA ($70): $1,227.101
• No spouse: no MMMNA/CSMIA deduction
• No dependents: no family allowance
• No IMEs: no medical deduction
• Patient liability: $1,227.10

The resident pays the facility $1,227.10 per month.2 Medicaid pays the facility the remainder of the contracted Medicaid rate.

HCBS Waiver Community Maintenance Allowance (300% SSI)

For Medicaid recipients in Georgia's HCBS waivers, EDWP (served through the CCSP or SOURCE model), ICWP, NOW, or COMP, who continue to live in the community (their own home, a family member's home, an assisted living facility under contract with the waiver, a small group home, or similar setting), the calculation is fundamentally different. The maintenance allowance is set much higher because the participant must pay for housing, food, utilities, transportation, and all the other costs of community living.4

Georgia's HCBS waiver maintenance allowance in 2026: Up to $2,982 per month, which equals 300 percent of the SSI Federal Benefit Rate (the same figure as the LTC Special Income Limit that gates waiver financial eligibility).3,4

How it works in practice. Most EDWP, ICWP, NOW, and COMP participants have income at or below the SIL of $2,982 (either by direct income or through a Miller Trust that funnels income through to the SIL). The full $2,982 (or the participant's actual income, whichever is lower) is then the maintenance allowance, meaning the participant typically owes zero or minimal cost share to the waiver.3,4

For participants whose income exceeds the SIL and who use a Miller Trust to qualify financially, the Miller Trust mechanics distribute income each month with the PNA-equivalent amount flowing to the participant for community living expenses, and the remainder either flowing to the state (typically zero for HCBS waiver participants) or accumulating in the trust subject to state-payback at death.

Comparison to NF PNA:

For more on the HCBS waivers, see our guides to the EDWP delivery models, CCSP and SOURCE, and the broader Georgia long-term care framework.

The Resident Trust Account at Georgia Nursing Facilities

Federal regulation at 42 CFR 483.10(f)(10) requires every Medicare- and Medicaid-certified nursing facility to manage resident funds in a specific way if the resident requests it. Most NF residents on Medicaid have their PNA deposited into a facility-managed resident trust account from which the resident or their representative can draw for personal expenses.

Federal requirements that apply to Georgia facilities:

• Separate accounting for each resident. Funds may be pooled for banking efficiency, but separate accounting must be maintained per resident.
• Interest-bearing account for balances over $50. Resident funds in excess of $50 must be held in an interest-bearing account, with interest credited to the resident's account.
• Quarterly written statements. The facility must provide each resident or their representative with a quarterly written statement of the account showing deposits, withdrawals, and current balance.
• Reasonable access. The resident or authorized representative must have reasonable access to withdraw funds during business hours, and after-hours access for emergency needs.
• Notice of approaching asset limit. If the resident's trust account balance is approaching the $2,000 categorical Medicaid asset limit, the facility must notify the resident and provide an opportunity to spend down before Medicaid eligibility is jeopardized.3
• Surety bond or equivalent protection. The facility must protect resident funds through a surety bond or equivalent so that funds are recoverable in case of facility insolvency.
• Return of funds at death or discharge. At the resident's death, the balance must be conveyed to the personal representative of the estate (typically requires letters of administration from probate court) within 30 days. At discharge, the balance must be returned to the resident.

Georgia-specific NF licensure rules at Rules of Georgia DCH 111-3-8 layer on additional state requirements, including state-specific reporting to DCH on resident funds management, audit requirements, and complaint procedures through the Department of Community Health Office of Healthcare Facility Regulation.

Practical points for families:

• Request and review the quarterly statement; verify that deposits match expected PNA inflows and that charges match expected expenses.
• Question any charges you do not recognize. Facilities sometimes charge for items the resident did not request or that should be covered by Medicaid.
• Keep records of the resident's preferences and the family member responsible for trust account decisions.
• File complaints with the Georgia Long-Term Care Ombudsman, the Division of Aging Services program that investigates complaints from facility residents, if the facility mishandles funds.8

What the PNA Can and Cannot Be Spent On

The PNA is intended for the resident's personal use and dignity.2 The federal and state rules do not provide a precise itemized list, but general categories apply.

Allowable categories:

• Clothing, including replacements, alterations, and special-occasion items beyond what the facility provides
• Personal toiletries beyond what the facility supplies (specialty soap, preferred deodorant, makeup, etc.)
• Hair care (cuts, styling, color)
• Snacks, food preferences, beverages outside the facility menu
• Telephone (landline or mobile)
• Magazines, newspapers, books, music
• Cable TV, streaming services, internet for personal devices (some facilities include in room rate; others require resident pay)
• Transportation for outside appointments, family visits, religious services, outings
• Religious or spiritual materials
• Hobbies, crafts, art supplies
• Personal furnishings (lamps, photos, small decorations) for the resident's room
• Greeting cards, postage, small gifts to family members (limited amounts to avoid transfer-penalty concerns)
• Personal grooming items, including over-the-counter health and beauty items
• Eyeglasses, hearing aids, dental work, and other health items not covered by Medicare or Medicaid (these may also qualify as Incurred Medical Expenses with deeper protection in the post-eligibility calculation)

Generally prohibited or restricted:

• Room and board. The facility cannot bill the resident's trust account for room and board; that is what Medicaid pays for.
• Services the facility is contractually obligated to provide. This includes basic nursing, basic personal care, basic food service, basic linens, basic transportation to medical appointments. If the facility tries to bill the trust account for these, file a complaint.
• Large gifts to family members. Substantial gifts (or smaller gifts accumulating to substantial annual amounts) can be treated as transfers for less than fair market value under 42 USC 1396p(c), triggering a Medicaid transfer penalty.
• Loans to family. Same transfer-penalty concern.
• Investments, securities, or other accumulating assets. The PNA should be spent for personal needs, not accumulated for non-allowable purposes.
• Services to non-residents. The trust account is the resident's, not the family's.

The $2,000 Asset Limit Interaction

Georgia categorical Medicaid for institutionalized individuals has a $2,000 asset limit ($3,000 for couples).3 The PNA balance counts toward this limit. If the trust account accumulates beyond approximately $1,800 (giving a safety margin), the resident is approaching the asset limit and must spend down before the next Medicaid redetermination.

Allowable spend-down items in addition to ordinary PNA categories:

• New clothing, especially larger purchases (winter coats, suits for special occasions)
• Replacement personal effects (luggage, jewelry replacing lost items, furniture for the resident's room)
• Dental work not covered by Georgia Medicaid (Georgia adult dental is limited)
• Hearing aids and audiology services beyond Medicare coverage
• Eyeglasses and vision services beyond Medicare coverage
• Customized wheelchair, scooter, or DME upgrades beyond Medicaid-covered standard equipment
• Prepaid funeral and burial contracts (these convert countable cash into an exempt prepaid funeral asset, often the single largest legitimate spend-down)
• Burial reserves (limited dollar amount of cash earmarked for funeral, exempt from countable assets)
• Personal computer or tablet (modest amount, depending on documentation as personal-use)

The prepaid funeral spend-down is often the most useful tool. Georgia allows a Medicaid recipient to purchase an irrevocable prepaid funeral contract with no dollar cap (subject to reasonable funeral industry pricing) without triggering a transfer penalty, and the contract is treated as an exempt asset. For residents whose trust account balance accumulates over time, prepaying a funeral converts several thousand dollars of cash into an exempt asset that the family does not have to pay out-of-pocket at death.

Failure to spend down. If the resident's trust account exceeds $2,000 at redetermination, Medicaid eligibility can be terminated.3 The resident becomes responsible for the full cost of facility care at private-pay rates until the balance is reduced back below $2,000. This can be devastating financially. The facility's social services and the family member or representative responsible for the trust account should monitor the balance monthly.

Veterans: Georgia Uses a $90 PNA Instead of the $70

Federal law at 38 USC 5503(d) caps the VA pension at $90 per month for veterans (or surviving spouses) who are receiving Medicaid-paid nursing facility care.5 The remaining VA pension that the veteran would have received is forfeited to the federal Treasury; it does not go to the state, to the Medicaid program, or to the facility.

Georgia's response is to change the allowance rather than to add to it. Chart A1.9 of the Georgia DFCS financial-limits appendix sets the PNA used in the patient liability budget at $90 for a VA pensioner or surviving spouse in a nursing home who has no dependents, and states that the VA check for these individuals 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 as any other resident.1

So a veteran in this situation keeps $90 a month, not $70 and not $70 plus $90. The $90 replaces the $70; it does not sit on top of it. The practical effect is that the capped VA check and the personal needs allowance are the same money: Georgia sets the allowance equal to the check so the facility cannot count that payment toward the cost of care.1,5

Mechanics:

• Veteran enters Medicaid-paid NF care
• VA receives notification of Medicaid coverage through data exchange
• VA reduces the monthly pension to $90 effective the month after Medicaid begins5
• The reduced pension is deposited directly into the veteran's account (typically the resident trust account at the facility)
• Georgia uses $90, not $70, as the PNA deduction in the patient liability budget for a veteran with no dependents1
• $90 is what is available for personal expenses

Aid and Attendance (A&A). Veterans receiving the A&A supplement to VA pension (additional monthly amount for veterans needing the aid and attendance of another person) have more complex treatment. Note first that the $90 ceiling applies to the pension as a whole, so an A&A amount paid as part of that pension sits inside the $90 rather than arriving on top of it.5 Medicaid handles the A&A amount in two separate steps. Under the SSI income methodologies a state uses to decide whether an aged, blind, or disabled applicant is financially eligible, the aid and attendance and housebound allowances are not income, so only the basic pension counts toward the income limit. In the post-eligibility patient-liability calculation, by contrast, income that was disregarded at eligibility must be considered, so the A&A amount does count toward what the resident owes the facility, before incurred medical expenses are deducted. Veterans receiving A&A should consult a Georgia elder law attorney or the Veterans Service Officer for their county before entering a Medicaid-paid nursing facility.

Georgia State Veterans Homes. Georgia operates state veterans homes through the Georgia Department of Veterans Service. These homes vary in their Medicaid contract status. Veterans considering admission should verify whether the home is Medicaid-certified, how the VA per-diem grant interacts with Medicaid, and whether the standard $90 VA cap applies.5 Locations include Augusta (Georgia War Veterans Home) and Milledgeville (Georgia War Veterans Nursing Home). Contact the Georgia Department of Veterans Service for specifics.

What Happens to the PNA When a Resident Dies or Transfers

At death. The balance in the resident trust account becomes part of the deceased's estate. The facility must convey the balance to the personal representative of the estate within 30 days under 42 CFR 483.10(f)(10). For most Georgia residents, this requires the family to open a probate estate and obtain letters of administration, then present the letters to the facility's business office. For small balances, Georgia's simplified small-estate affidavit procedures under O.C.G.A. Title 53 may apply.

The PNA balance is subject to Georgia probate creditor priority. If the deceased was an LTSS Medicaid recipient at age 55 or older, Georgia estate recovery may apply against the probate estate, including the PNA balance, after administrative costs and funeral expenses. See our Georgia estate recovery guide for the full framework.

Pre-arranged funeral. If the resident pre-arranged a funeral while alive and the trust account funded the pre-arrangement, those funds were already converted to an exempt asset and are not part of the probate estate.

At transfer to another facility. If the resident transfers to a different NF (whether Medicaid or private-pay) or to a community setting (HCBS waiver, assisted living, home), the original facility must return the balance to the resident or representative within 30 days. The funds can then be deposited in a new resident trust account or in a personal account for the resident.

At hospital admission. Short-term hospital admissions do not require trust account transfer. The facility holds the funds during the absence.

Three Worked Examples

The names, incomes, and dollar figures below are illustrative hypotheticals chosen to show how the deduction order works; your own numbers will differ. The deduction rules and the standard figures they use (the $70 PNA, the $202.90 Part B premium, the MMMNA floor and ceiling, the $90 VA cap) are the real 2026 amounts.1,6,7,5

Example 1: Widowed single resident with Social Security only

Mrs. Henderson is 82, widowed, with no children dependent on her. Her only income is $1,400 per month in Social Security retirement benefits. She is admitted to a Medicaid-paid nursing facility in DeKalb County.2

Post-eligibility calculation:

• Gross income: $1,400
• Minus Medicare Part B premium ($202.90): $1,197.106
• Minus PNA ($70): $1,127.102,1
• No spouse: no MMMNA/CSMIA
• No dependents: no family allowance
• No IMEs: no medical deduction
• Patient liability to facility: $1,127.10 per month

Mrs. Henderson keeps $70 per month in her resident trust account for personal expenses.1

Example 2: Married resident with community spouse below MMMNA

Mr. King is 78. He has been admitted to a Medicaid-paid nursing facility in Fulton County. His wife Carol, 76, continues to live in their home in the community. Mr. King's gross income is $2,500 per month from Social Security and a small pension. Carol's gross income is $1,800 per month from her own Social Security.7

Step one: determine Carol's MMMNA. Suppose Carol's verified shelter costs (mortgage, taxes, insurance, utilities, food allowance) total $4,000 per month. The MMMNA is the greater of the floor ($2,705.00) or the MMMNA + Excess Shelter Allowance, capped at the ceiling ($4,066.50). For Carol, the calculation runs to the ceiling of $4,066.50 because her shelter costs exceed the floor by more than the available shelter allowance gives.7

Step two: determine CSMIA. Carol's own income of $1,800 is below her MMMNA of $4,066.50. The shortfall is $2,266.50, which must be shifted from Mr. King's income to Carol.7

Step three: Mr. King's post-eligibility calculation. The CSMIA shift cannot exceed the income Mr. King has left after the Part B premium and PNA are deducted, so it is capped at $2,227.10 rather than the full $2,266.50 shortfall:7

• Gross income: $2,500
• Minus Part B premium ($202.90): $2,297.106
• Minus PNA ($70): $2,227.101
• Minus CSMIA shift to Carol (capped at $2,227.10): $0
• Patient liability to facility: $0

Mr. King keeps $70 per month for personal expenses. Carol receives $1,800 (her own income) plus $2,227.10 (CSMIA from Mr. King) = $4,027.10 per month, just short of her MMMNA but the maximum possible from Mr. King's available income.1

Note: In real practice, this scenario shows how the spousal protections can leave very little or no patient liability for the facility. Medicaid covers the entire facility cost. This is exactly the situation the federal spousal impoverishment rules at 42 USC 1396r-5 were designed to prevent (the community spouse being pauperized to pay for the institutionalized spouse's care).

Example 3: Veteran with VA pension cap

Mr. Robinson is 76, a Korean War veteran, widowed. Before NF admission he received $1,200 per month in Social Security and a $1,500 per month VA pension (with Aid and Attendance supplement for which he had qualified due to need for ADL assistance). He is admitted to a Medicaid-paid nursing facility in Chatham County.5

Effect of NF admission on VA pension. Under 38 USC 5503(d), once Medicaid begins paying for NF care, VA pension is reduced to $90 per month.5 The cap applies to the pension as a whole, so the Aid and Attendance supplement he had been receiving is inside that $90 rather than paid on top of it.5

Effective monthly income after VA reduction:

• Social Security: $1,200
• VA pension (capped): $905
• Total: $1,290

Post-eligibility calculation:

• Gross income: $1,290
• Minus Part B premium ($202.90): $1,087.106
• Minus PNA ($90, because he is a VA pensioner with no dependents, not the standard $70): $997.101
• No spouse: no MMMNA/CSMIA
• No dependents: no family allowance
• No IMEs: no medical deduction
• Patient liability to facility: $997.10

Mr. Robinson keeps $90 per month in his resident trust account. That is $20 more than the $70 a non-veteran resident keeps, and it is the whole of his personal money: the $90 PNA and the capped $90 VA check are the same $90, not two separate deposits.5,1

Practical point. Mr. Robinson's family should verify the VA pension reduction with the VA Regional Office to ensure the change was processed correctly. Some veterans have had VA pension continue at the pre-Medicaid level for several months after Medicaid begins, creating an overpayment situation that VA later recovers.

Common Mistakes Families Make

1. Confusing the $70 NF PNA with the $2,982 HCBS waiver community maintenance allowance. The two are very different and apply to different settings.1,3
2. Not subtracting Medicare Part B premium first in the post-eligibility calculation. Premiums come before PNA in the deduction order.
3. Not establishing CSMIA when the community spouse's income is below MMMNA. This is the single most expensive mistake families make. Without CSMIA, the institutionalized spouse's income flows to the facility rather than supporting the community spouse.
4. Letting the trust account balance exceed the $2,000 asset limit. Active monthly monitoring and spend-down on allowable items is necessary.
5. Believing the PNA can be gifted to family without consequence. Large gifts can trigger transfer-penalty review.
6. Expecting the VA $90 and the Georgia $70 to add up to $160. They do not. For a VA pensioner or surviving spouse with no dependents, Georgia uses $90 as the PNA in place of the $70, and the VA check is reduced to that same amount, so $90 is the total. A VA pensioner with dependents gets the standard $70.1
7. Not reviewing the resident trust quarterly statements for unauthorized charges. Facilities sometimes charge for items the resident did not request or that should be Medicaid-covered.
8. Trying to use the PNA to pay for room and board. Medicaid covers these; the facility cannot bill the trust account.
9. Forgetting that the resident representative cannot use the trust account funds for their own expenses. The funds belong to the resident.
10. Not knowing the facility must return the trust account balance at death or transfer. Within 30 days under federal rule.
11. Confusing the Georgia $70 PNA with other states. Each state sets its own NF PNA at or above the $30 federal floor; Pennsylvania, for example, is $60.2,9
12. Not factoring Incurred Medical Expenses (IMEs). Out-of-pocket medical costs for services not covered by Medicare or Medicaid can reduce patient liability and free up more of the resident's income.

Bottom Line for Georgia Families

In a Georgia nursing facility, the Personal Needs Allowance is the only money a Medicaid resident keeps each month for anything beyond what the facility provides: $70, above the $30 federal floor but modest, so families often supplement it from outside funds.1,2 The order of deductions that produces it (health insurance premiums, PNA, spousal MMMNA/CSMIA, dependent allowance, Incurred Medical Expenses, then patient liability) is worth working through with the facility's business office and, where a spouse or veteran's benefits are involved, an elder law attorney.

If the resident lives in the community on an HCBS waiver instead, the picture changes sharply: the maintenance allowance rises to $2,982 per month in 2026 because the participant now pays for their own housing, food, and utilities.3,4 That gap is one of the strongest financial reasons families pursue a waiver when clinical eligibility allows.

Learn More

Find personalized help navigating Georgia Medicaid nursing facility rules 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.