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

In 2026, the Nebraska Medicaid Personal Needs Allowance lets a nursing home resident keep $75 a month for personal expenses. The rest of their income, after a few other deductions the rules allow, goes toward the cost of their care.1,2 That $75 is small, but it's protected by law, and understanding how it works, where the money is held, and what the facility can never charge against it will save a family real money and real frustration.

In This Guide

• What Is the Nebraska Medicaid Personal Needs Allowance?
• How Nebraska's Allowance Compares to the Federal Floor
• How the Money Is Held: The Resident Trust Fund
• Where the Nebraska Medicaid Personal Needs Allowance Fits in Your Bill
• What the Facility Must Provide and Cannot Bill to the Allowance
• Veterans and the VA Pension Rule
• Frequently Asked Questions
• Learn More

What Is the Nebraska Medicaid Personal Needs Allowance?

When someone moves into a nursing facility and Medicaid pays for their care, they don't hand the facility a rent check out of pocket. Instead, Medicaid pays the facility directly, and the resident's own monthly income, their Social Security, a pension, an annuity, gets applied toward that cost after a few protected amounts come off the top.2 If nothing were held back, the resident's entire check would flow to the facility and they'd have nothing left for a haircut, a phone bill, or a birthday card for a grandchild.

The Personal Needs Allowance is the piece the law sets aside so that doesn't happen. It's a fixed monthly amount the resident keeps for personal expenses before the rest of their income, less any other allowed deductions, is counted toward the bill.2 In Nebraska, Medicaid is run by the Department of Health and Human Services (DHHS) Division of Medicaid and Long-Term Care, and the DHHS published income and resource standards set the nursing facility allowance at $75 a month for 2026.1

Who gets it? Any resident whose long-term nursing facility stay is paid by Nebraska Medicaid. The allowance isn't something you apply for separately, it's built into how the state calculates what a Medicaid resident owes the facility each month.1,2 It exists to protect a small measure of dignity and choice: the money is the resident's own, to spend on the things a facility doesn't provide.

A quick note on wording. You'll see the same idea called the Personal Needs Allowance, the "PNA," or a "personal needs account." The Social Security Administration runs the SSI (Supplemental Security Income) program many residents draw income from, but SSI and the Personal Needs Allowance are two different things: SSI is income coming in, and the allowance is the slice of that income the resident is allowed to keep.

How Nebraska's Allowance Compares to the Federal Floor

Federal law sets a floor, not the actual number. Under the rules every state must follow, a nursing facility resident has to be allowed to keep at least $30 a month, and an institutionalized couple has to keep at least $60 a month when both spouses are aged, blind, or disabled and their incomes are counted together. That $30 figure was set by a 1987 federal law that took effect in 1988, and it has never been raised since.2

A state must set its allowance at or above that $30 and is free to set it higher, as Tennessee does at $70. Nebraska went higher too: its $75 nursing facility allowance is two and a half times the federal minimum.1,2 The practical takeaway is simple. Nebraska residents keep more of their income for personal use than residents in a state that never raised its allowance above the federal floor, but $75 is still a modest sum, so it pays to spend it deliberately and watch the account closely.

It also helps to know where the number comes from. The $75 isn't a rough estimate or a national average, it's the figure printed on Nebraska DHHS's own published income and resource standards table.1 If a facility or a caseworker ever quotes you a different amount for a standard nursing facility stay, that's worth questioning against the state's published standard.

How the Money Is Held: The Resident Trust Fund

The $75 doesn't just sit in an envelope. Under the federal nursing-facility rules, a resident has the right to manage their own money, and a facility can't force a resident to deposit funds with it. But if a resident chooses to deposit money with the facility and authorizes it in writing, the facility has to act as a fiduciary, meaning it's legally responsible for handling the funds honestly and keeping them separate from its own accounts. This account is usually called the resident trust fund.3

Here's what the facility is required to do with a Medicaid resident's money:

• Keep any balance above $50 in an interest-bearing account that's separate from the facility's operating accounts.3
• Maintain a full, separate accounting for each resident, with no mixing of resident funds and facility funds.
• Make the individual financial record available to the resident, both through quarterly statements and on request.3
• Protect the funds with a surety bond or a similar guarantee, so the money is recoverable if the facility fails.
• Convey the balance and a final accounting within 30 days when the resident is discharged, is evicted, or dies; after a death, it goes to whoever is administering the resident's estate.3

That last point matters for families. When a resident dies, the trust fund balance doesn't vanish and the facility doesn't get to keep it, it has to be turned over within 30 days, with a final accounting, to the person or probate court handling the estate.3

The most useful thing a family can do is treat the account like any other bank account: ask for the statements, read them, and reconcile them against what you know the resident actually bought. A trust fund with a small monthly deposit is easy to overlook, but it's the resident's money, and the facility owes a clear paper trail for every dollar in and out.

One thing to keep an eye on is the balance itself. The allowance is the resident's to spend, and money that sits unspent in the trust fund is still the resident's own savings, no different from cash in a checking account. Nebraska sets a countable resource limit of $4,000 for a single Medicaid applicant.1 As a practical matter, then, a trust fund left to grow for a year or two, on top of any other savings a resident holds, is worth watching so the balance doesn't drift up toward that limit. The fix is straightforward: spend the allowance on the resident's needs rather than letting it accumulate, and check with the resident's caseworker if the balance is climbing.

Where the Nebraska Medicaid Personal Needs Allowance Fits in Your Bill

To see why the allowance matters, it helps to walk through how Nebraska decides what a resident contributes toward care each month. That contribution has a few different names, patient liability, share of cost, or the resident's "obligation," but it's the same idea: the amount of the resident's own income that goes to the facility.

Nebraska runs a Medically Needy program for people whose income is over Medicaid's limits but who face costly medical bills. They must obligate their monthly income above the Medically Needy Income Level, $392 a month for one person, to those bills to become eligible, an amount called the share of cost. When that share of cost is owed to a nursing home, it's paid directly to the facility.1 For a nursing facility resident, the state starts with the resident's gross monthly income and subtracts a set of protected amounts before arriving at what's owed to the facility. The Personal Needs Allowance is the first of those subtractions.

In plain order, the calculation for a single resident looks roughly like this:

1. Start with the resident's total monthly income (Social Security, pension, and so on).
2. Subtract the $75 Personal Needs Allowance.1
3. Subtract certain health-insurance costs the resident still pays, such as a Medicare Part B premium.2
4. What remains is the resident's monthly contribution to the facility.

So the allowance sits right at the top of the deductions. Every dollar of the $75 is a dollar that stays with the resident instead of flowing to the facility.1 Income above the allowance and the other protected deductions is what goes toward the cost of care.

If the resident is married and a spouse still lives at home, the math changes in the spouse's favor. Nebraska's spousal-impoverishment rules can shift some of the resident's income to the community spouse, which lowers what the resident owes the facility.1 That's a separate protection from the Personal Needs Allowance, and a married couple should look at our Nebraska spousal impoverishment guide for the full picture.

What the Facility Must Provide and Cannot Bill to the Allowance

This is where a family can lose money without realizing it. The $75 allowance is meant for the extras, not for things the facility already has to provide. Federal law lists a set of routine items and services that are included in the facility's daily Medicaid payment, and during a covered stay the facility cannot turn around and charge the resident for them, or bill them against the Personal Needs Allowance.5

The items the facility must provide as part of its payment include:

• Nursing services and food and nutrition services.
• An activities program and medically related social services.
• Room and bed maintenance, and basic personal laundry.
• Routine personal hygiene items, such as a comb and brush, bath soap, a razor and shaving cream, a toothbrush, toothpaste, denture cleaner, and moisturizing lotion.
• Hair and nail hygiene services, bathing assistance, incontinence care and supplies, towels and washcloths, and over-the-counter drugs.
• Hospice services the resident has chosen, when Medicare or Medicaid pays for them.5

These are already paid for through the facility's daily rate, so the facility can't bill them to the resident's personal funds.5 That leaves the $75 for what it's actually meant to cover: personal clothing, a preferred brand of shampoo or a salon visit beyond basic hair care, snacks, phone and postage, magazines, hobby supplies, and small gifts.

The facility can lawfully charge the resident's funds for some extras, such as a telephone, a television, personal clothing, reading matter, gifts, grooming beyond the covered basics, or a private room that isn't medically needed. It may do so only if the resident asks for the item, the care plan doesn't require it, the facility says up front that there will be a charge, and Medicare or Medicaid isn't paying for it.5

If you review a trust fund statement and see charges for basic hygiene supplies, routine laundry, or over-the-counter medicine, that's a red flag worth raising with the facility and, if it isn't corrected, with Nebraska DHHS. Knowing exactly which items the facility owes the resident makes it much easier to catch charges that shouldn't be eating into the allowance.

Veterans and the VA Pension Rule

Veterans have a rule of their own here, and it changes both what the pension pays and what a family should be asking the caseworker. A veteran who receives a Department of Veterans Affairs (VA) pension and who has no spouse or child is subject to a federal cap once Medicaid is paying for their nursing facility care: under the federal statute, no more than $90 a month of the VA pension may be paid to them for any period after the month they're admitted. VA's own regulation counts instead from the month Medicaid payments begin, so confirm with VA which month the reduction starts. The same cap applies to a surviving spouse with no child.4 There is a setting that cap doesn't reach: federal law defines the nursing facilities this rule covers so as to exclude a state veterans home for which the VA makes per diem payments for nursing home care, so a Medicaid-covered veteran living in one of those homes isn't held to the $90 figure.4

The important part is what happens to that $90 in an ordinary nursing home. Federal law says the facility's Medicaid payment can't be reduced by the amount of pension the veteran keeps, so the $90 doesn't flow to the facility, it stays with the veteran.4 What federal law doesn't settle is how that $90 sits next to a state Personal Needs Allowance, because that interaction is decided by each state's own post-eligibility rules, and states have answered it in opposite directions, some leaving the resident holding both amounts and some treating the capped pension as the allowance itself.4 Nebraska's own DHHS standards table lists a veterans personal needs figure of $90, marked excluded, beside the $75 nursing facility standard, without spelling out how the two interact.1

So before a family plans around a combined number, ask the Medicaid caseworker how Nebraska applies that $90 exclusion against the $75 allowance, then check the answer against the monthly obligation on the eligibility notice, which is where it actually shows up.1,4 These are two protections from two different laws, and it's the state one, not the VA rule, that decides how they fit together. The rule works differently for a veteran with a spouse or child, so married veterans should confirm their situation with both a VA-accredited representative and their Medicaid caseworker.

Learn More

Find personalized help understanding your Nebraska Medicaid 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.