Maryland Medicaid Personal Needs Allowance (2026): $106/Month

The Maryland Medicaid personal needs allowance lets a nursing home resident keep $106 a month, one of the most generous figures in the country. Nearly all of a resident's other income goes to the facility as their share of the cost of care, but this small, protected amount stays theirs to spend on clothing, haircuts, a phone bill, or a birthday gift.1

What Is the Maryland Medicaid Personal Needs Allowance?

When someone qualifies for Medicaid to pay for a nursing home, they don't pay the facility rent out of pocket. Instead, Medicaid pays the facility directly, and the resident is expected to contribute nearly all of their own monthly income toward that cost. That contribution is called the resident's patient liability, or share of cost.

Federal law recognizes that leaving a resident with nothing would be unworkable and undignified. So before the share of cost is calculated, the state sets aside a small amount of the resident's income for personal expenses the facility doesn't cover. That protected amount is the personal needs allowance, and in Maryland it comes to $106 a month in 2026.1

The allowance is the resident's to spend as they choose. Think of the everyday things a nursing home doesn't provide: a preferred brand of shampoo, a haircut at the in-house salon, stamps and greeting cards, a magazine subscription, snacks, a phone or streaming service, or a small gift for a grandchild. Without the allowance, every dollar of a resident's Social Security check would flow straight to the facility, leaving nothing for personal choice.

Who gets it? Any Maryland Medicaid recipient living in a nursing facility whose income is being applied to their cost of care. The Maryland program, called Medical Assistance, is run by the Maryland Department of Health. If your loved one is on Medicaid in a nursing home in Maryland, the $106 allowance is theirs by law, and the facility must account for it.1

How the Maryland Medicaid Personal Needs Allowance Compares to the Federal Floor

The personal needs allowance is a federal requirement, but Congress only sets a minimum. Under 42 U.S.C. 1396a(q) and 42 CFR 435.725, the floor is at least $30 a month for one aged, blind, or disabled resident, and at least $60 a month for an institutionalized couple if both spouses are aged, blind, or disabled. That $30 figure has been frozen since the Omnibus Budget Reconciliation Act of 1987 took effect in July 1988, so inflation has quietly eroded its value for nearly four decades.2

States are free to set their allowance higher than the floor, and most do. Maryland is on the generous end. Its $106 monthly allowance is more than three times the federal minimum and sits among the highest state figures in the country, where amounts commonly range from the $30 floor up to roughly $200.1,2

The table below lays out the Maryland figures alongside the federal minimums and the other protected amounts that can come into play.

A quick note on the couple figures: the $60 federal amount applies only when both spouses are institutionalized. If one spouse stays in the community, a separate and much larger protection kicks in, the community spouse income allowance, which lets the at-home spouse keep monthly income in the federal range of $2,705 to $4,066.50 in 2026. That's a different rule from the personal needs allowance, but it often matters to the same families.1

Where Your Money Is Held: The Resident Trust Fund

Once the allowance is set aside, where does it actually go? A resident can keep and manage their own money, or they can ask the facility to hold it for them in what's called a resident trust fund (sometimes a resident personal-funds account). Federal rules at 42 CFR 483.10(f)(10) spell out exactly how the facility must handle those funds, and the protections are worth knowing.3

A facility may not require a resident to deposit personal funds with it. If a resident does choose to let the facility hold the money, the facility takes on a fiduciary duty and must:

• Keep the funds in an account separate from the facility's own operating accounts, with no mixing of resident money and facility money. For a Medicaid resident, any balance over $50 must sit in an interest-bearing account, and the interest belongs to the resident.3
• Maintain a full, separate accounting and make it available to the resident through quarterly statements and on request.
• Protect the money with a surety bond or other assurance acceptable to the federal government.
• Within 30 days of the resident's death, turn over the funds and a final accounting to the person or probate court handling the estate.

A practical habit for families: ask for the quarterly statement, and read it. Facilities don't always send it without a nudge. Compare it against what you know was actually spent, and raise any discrepancy in writing. One balance to keep an eye on is the trust-fund total itself, because it counts toward Maryland's Medicaid asset limit of $2,500 for one person. Let an unspent allowance pile up for a couple of years and a resident can drift toward that limit, so it's usually better to spend the allowance down each month than to bank it.1

Patient Liability: Where the Allowance Fits in the Math

The personal needs allowance makes the most sense once you see where it sits in the patient-liability calculation. Every month, the state works out how much of a nursing home resident's income goes to the facility, and the allowance is one of the deductions taken off the top before that number is set.

Here's the order in plain terms. Start with the resident's gross monthly income, everything coming in: Social Security, a pension, an annuity, and so on. From that, the state subtracts a set of protected amounts:

1. The $106 personal needs allowance.1
2. A community spouse income allowance, if a husband or wife still lives at home and needs support, up to the federal maximum.1
3. Certain health-insurance premiums the resident pays, such as Medicare Part B or a Medigap policy.

Whatever is left after those deductions is the patient liability, the amount the resident pays the facility each month. Medicaid covers the rest of the bill. The allowance never flows to the facility; it's the slice of income the resident keeps.

What the Facility Must Provide and Cannot Bill to You

A common worry is that a facility will nickel-and-dime a resident's allowance for everyday care. Federal rules guard against exactly that. Under 42 CFR 483.10(f)(11), a set of routine items and services is already paid for by Medicaid's daily rate, so during a covered stay the facility must not charge the resident for them, and it cannot bill them against the personal needs allowance.4

That protected list includes nursing services, meals and nutrition services, an activities program, room and bed maintenance, and routine personal hygiene items and services. The hygiene category is broad on purpose. It covers hair-hygiene supplies, a comb and brush, bath soap, a razor and shaving cream, a toothbrush and toothpaste, denture adhesive and cleaner, moisturizing lotion, incontinence care and supplies, towels and washcloths, over-the-counter drugs, basic hair and nail care, bathing assistance, and basic personal laundry.4

So what is the allowance actually for? The extras beyond that baseline: a preferred brand instead of the basic supply, a salon perm or color, restaurant meals on an outing, books and magazines, stamps, a phone or streaming subscription, hobby supplies, and gifts. If you ever see a charge against a resident's trust account for something on the protected list, ask the facility to explain it, and if it isn't resolved, raise it with the Maryland Long-Term Care Ombudsman, which investigates complaints about resident funds and facility billing.

If You're a Veteran: How the VA Pension Cap Works

A veteran on a needs-based VA pension runs into a special rule once Medicaid is paying for nursing home care. Under 38 U.S.C. 5503(d), when a veteran who has neither a spouse nor a child is covered by Medicaid for nursing-facility services, no VA pension above $90 a month may be paid for any period after the month of admission. In effect, the pension is reduced to $90.5

The part families often miss is that this $90 is protected, not lost. The same statute says the Medicaid payment to the facility may not be reduced by the pension the veteran keeps, so the $90 stays with the veteran rather than flowing to the nursing home. A single, childless veteran on Medicaid nursing-home care therefore keeps that $90 VA pension in addition to Maryland's $106 personal needs allowance.5,1

The $90 figure is fixed in federal law and doesn't rise with cost-of-living adjustments. It also applies to the specific situation the statute describes, a veteran with no spouse and no child. A veteran who has a spouse at home or a dependent child is in a different situation, and the pension treatment can differ, so it's worth confirming the details with a county veterans service officer and the Medicaid caseworker together before assuming a number.5

Learn More

Find personalized help understanding the Maryland Medicaid personal needs allowance 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.