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

The Maryland Medicaid personal needs allowance lets a nursing home resident keep $106 a month, more than three times the $30 federal minimum. After this and a few other allowed deductions, the rest of a resident's 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.1,2

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 most of their own monthly income, after certain allowed deductions, toward that cost.2 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, the share of cost would take the money a resident now uses for personal choices.

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 and their incomes are considered available to each other. Those $30 and $60 figures have been unchanged since the Omnibus Budget Reconciliation Act of 1987 added them for calendar quarters beginning on or after July 1, 1988, so inflation has quietly eroded their value for nearly four decades.2

States are free to set their allowance higher than the floor, and Maryland does. Its $106 monthly allowance is more than three times the federal minimum.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 to an institutionalized couple whose incomes are counted together.2 If one spouse stays in the community, a separate and much larger protection kicks in, the community spouse income allowance. Federally, it can bring the at-home spouse's monthly income up to a floor of $2,705 (effective July 1, 2026), with a 2026 maximum of $4,066.50, and a fair hearing can raise it further when exceptional circumstances cause significant financial duress.5 Maryland's own published schedule still shows a $2,643 basic allowance and a $4,066 maximum, so confirm the figure the state is using with the caseworker.1 That's a different rule from the personal needs allowance, but it often matters to the same families.

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 deposit money with the facility and authorizes it in writing, the facility takes on a fiduciary duty and must:3

• 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.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.
• Tell a Medicaid resident when the account reaches $200 less than the Supplemental Security Income (SSI) resource limit for one person, and warn that going over the limit could cost the resident Medicaid or SSI eligibility.
• Within 30 days of the resident's discharge, eviction, or death, turn over the funds and a final accounting to the resident, or after a death to the person or probate court handling the estate.3

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 for one person: $2,500 under the medically needy pathway, or $2,000 under the categorically needy one. 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 several deductions taken off the top before that number is set.2

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, federal rules have the state subtract 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, normally up to the federal maximum.5
3. A maintenance allowance for other family members living at home.
4. Medical costs no one else pays, including Medicare Part B or Medigap premiums, deductibles, and coinsurance.
5. Any continued SSI or state supplement benefits.

The state may also protect an amount to keep up the resident's home for up to six months when a doctor certifies the resident is likely to return home.2

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 has seven categories: nursing services, food and nutrition services, an activities program, room and bed maintenance, routine personal hygiene items and services, medically related social services, and hospice care paid for by Medicare or Medicaid. 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. Federal rules list what a facility may charge to a resident's funds, including a phone, a TV or computer for personal use, cosmetic and grooming items beyond the covered ones, personal clothing, reading material, gifts, flowers, outings beyond the activities program, privately hired aides, and a private room that isn't medically needed. Even then, the facility can charge only if the resident asked for the item, it isn't needed for the care plan, the facility said up front there would be a charge, and Medicare or Medicaid isn't paying for it.4 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 advocates for the rights of nursing home residents.6

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. The same cap applies to a surviving spouse with no child and to a surviving child entitled to pension. VA's own regulation, 38 CFR 3.551(i), starts the cap after the month Medicaid payments begin rather than the month of admission, so if Medicaid approval came months after admission, confirm with VA which month the reduction runs from. Either way, a beneficiary isn't liable to repay pension VA failed to reduce on time, unless they willfully concealed the information VA needed.7

Which building the veteran lives in decides whether that cap applies at all. The statute defines the facilities it covers at 38 U.S.C. 5503(d)(1)(B), and that definition leaves out a State home the VA makes per diem payments for under 38 U.S.C. 1741(a). A Medicaid-covered veteran living in a State veterans home for which the VA makes those per diem payments is outside the $90 cap, so the reduction described above does not apply to that veteran. Not every facility that calls itself a veterans home is one the VA pays that per diem for, so ask the home's business office whether it receives VA per diem for nursing home care before counting on the exception.7

The part families often miss is what the cap is paired with when it does apply. The same statute says the Medicaid payment to the facility may not be reduced by the pension the veteran keeps, which means the state can't recover the $90 through what it pays the nursing home.7

What the statute doesn't address is the state personal needs allowance. It never mentions one. Whether that $90 is kept on top of Maryland's $106 allowance or takes its place is a question of state Medicaid policy, and states answer it in opposite directions.7 Maryland's answer isn't safe to assume in either direction, so a family shouldn't budget on the two amounts together until the Medicaid caseworker confirms how the pension is being counted. The patient-liability figure on the eligibility notice is where it shows up.1

The $90 figure is written into the statute, and this part of the law is set to expire January 31, 2033. It applies only to the situations the statute describes: a veteran with no spouse and no child, a surviving spouse with no child, or a surviving 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.7

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.