Montana Medicaid Personal Needs Allowance (2026): What You Keep

In 2026, $50 a month is what a Montana Medicaid nursing facility resident keeps as a Personal Needs Allowance, while the rest of their income goes to the facility toward the cost of care. That protected slice is the Montana Medicaid Personal Needs Allowance, the money the state sets aside for the small things Medicaid and the nursing home don't cover, like clothing, a haircut, phone service, or a birthday gift for a grandchild.1

In This Guide

• What Is the Montana Medicaid Personal Needs Allowance?
• How the Montana Medicaid Personal Needs Allowance Compares to the Federal Floor
• How Your Money Is Held: The Resident Trust Fund
• Where the Allowance Fits in Your Patient Liability
• What the Facility Must Provide Without Touching Your Allowance
• If You're a Veteran: The VA Pension Rule
• Frequently Asked Questions
• Learn More

What Is the Montana Medicaid Personal Needs Allowance?

When someone qualifies for Medicaid long-term care and moves into a nursing facility, they don't pay rent or a room-and-board bill the way they would at an assisted living community. Instead, Montana Medicaid, run by the Montana Department of Public Health and Human Services (DPHHS), pays the facility directly, and nearly all of the resident's own monthly income, Social Security, a pension, an annuity, gets counted toward that bill.

The Personal Needs Allowance (PNA) is the exception. It's the piece of income the state protects so the resident isn't left with nothing of their own. In Montana, that allowance is $50 a month for a nursing facility resident. A resident whose only income is Supplemental Security Income (SSI) keeps a smaller allowance of $30 a month, because SSI is already a needs-based benefit set at a lower level.1

Fifty dollars isn't much, and it isn't meant to cover the cost of care. It's meant to cover the personal things a nursing home and Medicaid don't: replacement clothing, a haircut or a perm, snacks and treats, a phone or a streaming subscription, postage and greeting cards, a small gift for a family member. The point is dignity and choice, that a resident has a little money that is genuinely theirs to spend as they wish.

Everyone in a Medicaid-funded nursing facility bed gets a Personal Needs Allowance; it isn't something you apply for separately. Once Medicaid is paying for the facility stay, the allowance is built into how your monthly income is divided, and the facility is required to set it aside for you.

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

Every state's Personal Needs Allowance rests on a federal minimum. Under federal Medicaid law, the institutional allowance must be at least $30 a month for an individual, and at least $60 a month for a couple when both spouses are institutionalized and both are aged, blind, or disabled. Those figures come from a 1988 federal law and have never been raised since, so a dollar of allowance today buys far less than it did when the floor was set.2

The federal amounts are a floor, not a ceiling. States are free to set their allowance higher, and most do; in 2026, state nursing facility allowances commonly run anywhere from the $30 floor up to roughly $200, with many states clustered between $50 and $80.2

Montana sits toward the lower end of that common range. At $50 a month, the Montana Medicaid Personal Needs Allowance is $20 above the federal individual floor, but it's below states that have pushed their allowances into the $70-and-up territory.1,2

Here's the practical takeaway: the $50 figure is what governs in Montana, and it's what the facility must set aside for a nursing home resident. The federal floor matters mostly as context, it tells you the state can't go lower than $30, and it explains why states with tight budgets sometimes stay near that minimum.1,2

How Your Money Is Held: The Resident Trust Fund

The $50 doesn't just vanish into a general account or come to the resident as loose cash. Under federal nursing-facility rules, the resident has the right to manage their own money, and the facility can't force anyone to hand their funds over. But most residents, or the family member helping them, do choose to let the facility hold the allowance, and when that happens the facility has to act as a careful steward of it.3

That account is usually called a resident trust fund. The rules that govern it are worth knowing, because they're what protect the resident's money:

• Any balance over $50 for a Medicaid resident has to sit in an interest-bearing account held for the resident, separate from the facility's own operating money. (The threshold is $100 for a resident who isn't on Medicaid.)3
• The facility has to keep a full, separate accounting of the resident's funds, with no mixing of resident money and facility money.
• The resident (or their representative) is entitled to a quarterly statement, and can ask to see the individual financial record at any time.3
• The facility has to secure all resident funds with a surety bond or a comparable assurance, so the money is protected even if the facility itself runs into trouble.
• When a resident dies, the facility has to turn over the funds and a final accounting within 30 days to the person or the probate court handling the estate.3

A word of practical advice: don't wait for the statement to show up on its own. Facilities are required to provide it, but families who ask for the quarterly statement in writing, and reconcile it against what they know the resident actually spent, are the ones who catch a bookkeeping error or a wrong charge early. Keep those statements. If your loved one is discharged or passes away, the final accounting is something you'll want in hand.

There's one more thing to watch. The trust fund balance counts as a resource for Medicaid eligibility, and a single Montana Medicaid recipient generally has to keep countable resources at or below $2,000. If the allowance is allowed to pile up month after month without being spent, the balance can drift toward that limit and put eligibility at risk. The fix is simple: spend the allowance on the resident, month to month, rather than letting it accumulate.1

Where the Allowance Fits in Your Patient Liability

To see where the $50 comes from, it helps to understand what happens to the rest of a resident's income.1 When Medicaid pays for a nursing home stay, the resident is expected to contribute most of their monthly income toward the cost of that care. The amount they contribute is called the patient liability (you may also hear it called the share of cost or the cost-of-care contribution).

Montana calculates the patient liability by starting with the resident's gross monthly income and then subtracting a set of protected amounts. The order looks roughly like this:

1. Start with gross monthly income, Social Security, pension, annuity, and similar.
2. Subtract the Personal Needs Allowance of $50 (or $30 for an SSI-only resident). This is the money the resident keeps.1
3. Subtract a monthly income allowance for a spouse who still lives in the community, if there is one, so the at-home spouse isn't left destitute. In 2026 the federal minimum monthly maintenance needs allowance is $2,705.00, with a ceiling of $4,066.50.5
4. Subtract certain health-care costs the resident pays out of pocket, such as a Medicare Part B premium or other non-covered medical expenses.
5. What's left is the patient liability, and it's paid to the facility each month as the resident's contribution.

Notice where the allowance sits: it comes out near the top, before the patient liability is figured, which is why the resident actually keeps it.1 The $50 isn't a payment the facility makes to the resident; it's income the resident was already receiving that the state simply refuses to count toward the bill. Everything above the protected amounts flows to the nursing home, and Medicaid covers the gap between that contribution and the full cost of care.

For a resident with a spouse at home, this math can shift a good deal of income to the community spouse, which lowers the patient liability but doesn't change the $50 the institutionalized resident keeps for personal needs. The allowance is fixed; it's the other deductions that vary with the household.1

What the Facility Must Provide Without Touching Your Allowance

One of the most useful things to understand about the Personal Needs Allowance is what it is not for. A common and costly misunderstanding is that the $50 has to stretch to cover routine care items the facility should be providing for free. It doesn't.1

Under federal nursing-facility rules, a whole set of routine items and services is already included in the daily rate Medicaid pays the facility, and during a covered stay the facility must not bill the resident for them or charge them against the Personal Needs Allowance. That covered list includes:6

• Nursing services and bathing assistance
• Food and nutrition services
• An activities program
• Room and bed maintenance
• Routine personal hygiene items and services, such as a comb and brush, bath soap, a razor and shaving cream, a toothbrush, toothpaste, denture adhesive and cleaner, moisturizing lotion, towels and washcloths, incontinence care and supplies, over-the-counter drugs, and basic personal laundry, along with hair and nail hygiene services

Because those are paid for through the facility's daily Medicaid rate, they can't be charged to the resident's personal funds.6

So what is the allowance for? The extras, the things beyond that basic level. A preferred brand of shampoo or lotion, a trip to a salon for a color or a perm, snacks and outings, magazines and books, a phone or cable or streaming service, postage, hobby supplies, gifts for grandchildren. If a facility ever tries to deduct the cost of a basic hygiene item or a covered service from a resident's trust fund, that's worth questioning; the facility's federal covered-items list is the reason.

If you're not sure whether a charge is legitimate, ask the facility to point to where the item falls outside the covered daily rate, and keep the answer with your trust-fund statements.

If You're a Veteran: The VA Pension Rule

Veterans and their families have one more rule to know, and it's a favorable one. A veteran who receives a VA pension from the U.S. Department of Veterans Affairs (VA), and who has neither a spouse nor a dependent child, faces a special limit once Medicaid is paying for their nursing facility care.

Under federal law, for a single, childless veteran 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 other words, the pension is reduced to $90 once Medicaid takes over the nursing home bill.4

The good news is what happens to that $90. Federal law also bars the facility's Medicaid payment from being reduced by the retained pension, which means the $90 stays with the veteran rather than flowing to the nursing home. The result: a single, childless veteran on Medicaid nursing facility care keeps that $90 VA pension in addition to the state's Personal Needs Allowance, rather than losing it to the cost of care.4

Two cautions here. First, this $90 rule is a federal VA rule with its own source, and the state Personal Needs Allowance is a separate Medicaid rule; each protects money for its own reason. Treat them as two distinct protections rather than assuming a single guaranteed total. Second, the $90 cap applies to a veteran with no spouse and no dependent child; a married veteran, or one with a dependent, is in a different situation, and the type of VA benefit matters too. If a veteran in the family is entering a nursing facility on Medicaid, it's worth confirming the specifics with both a VA pension representative and a Montana Medicaid eligibility caseworker before counting on any particular figure.4

Learn More

Find personalized help understanding the Montana Medicaid Personal Needs Allowance and nursing home 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.