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

Effective January 1, 2026, the Ohio Medicaid Personal Needs Allowance (PNA) for nursing facility residents increased from $50 to $75 per month under OAC Rule 5160:1-6-07. The Assisted Living Waiver leaves residents a $50 monthly cushion instead. The federal floor under 42 USC § 1396a(q) has been $30 since 1988. This guide covers what the PNA is, who gets which amount, how the Resident Trust Fund works, what families should know about spending and accounting, the VA pension stacking rule, and the Patient Liability deduction order.1,2

In This Guide

• The 60-Second Version
• What Is the Ohio Medicaid Personal Needs Allowance?
• 2026 Ohio PNA Numbers, All Settings
• Why Ohio Raised the NF PNA (and Why ALW Was Left Out)
• The Resident Trust Fund: How Your Money Is Held
• Patient Liability, Where the PNA Fits in the Math
• HCBS Waiver Maintenance Allowances (PASSPORT, ALW, Ohio Home Care, MyCare)
• Allowable and Prohibited Spending
• Working Residents and the Extra Earned-Income Deduction
• VA Pension Plus PNA: The Stacked Personal Funds
• When the PNA Balance Approaches the Asset Limit
• Death of a Resident, Where the Money Goes
• Power of Attorney, Guardianship, and Resident Representative Rules
• ICF/IID Residents
• The Federal Floor and the PNA Modernization Act
• Ohio PNA History 1988 to 2026
• Where to Get Help When PNA Is Mishandled
• Three Worked Examples
• 10 Ohio-Specific PNA Pitfalls
• Pending Policy Watch
• Frequently Asked Questions
• Related Reading

The 60-Second Version

If your loved one is in an Ohio Medicaid-paying nursing facility:

1. Their personal allowance is $75 per month (raised from $50 effective January 1, 2026).1
2. They keep the $75 in a Resident Trust Fund account that the facility administers under OAC 5160-3-16.5 and 42 CFR § 483.10(f)(10).
3. Quarterly statements are required within 30 days of each quarter end.
4. Balances over $50 must be in an interest-bearing account; interest belongs to the resident.
5. If they have earned income from a job, they keep up to an extra $65/month on top of the $75.1
6. If they're a veteran on VA pension with no spouse or dependent child, the VA reduces the pension to $90/month after Medicaid NF placement, and Ohio excludes that $90 at OAC 5160:1-6-07(I)(2)(j) before the PNA step, so they keep the $90 PLUS the $75 PNA, a stacked $165 in personal funds.4,1
7. If they're in an Assisted Living Waiver setting (not a nursing facility), the monthly cushion is still $50, because the room-and-board cap leaves that much and Ohio did not extend the $75 nursing-facility figure to ALW residents. This is a known gap that advocates are pushing to fix.2
8. If they're on the PASSPORT, Ohio Home Care, or MyCare waiver living at home, the math is different, they use the SIMNA structure (65% of the Special Income Level, published by ODM as $1,939/month for 2026) instead of a $75 PNA. A MyCare member living in an assisted living facility instead gets the ALMNA.3
9. Ohio's $75 PNA is 2.5 times the $30 federal floor. For another state's figure, confirm the current amount with that state's Medicaid agency.1

What Is the Ohio Medicaid Personal Needs Allowance?

When an individual receives Medicaid-funded nursing facility (NF) or institutional care, they don't pay rent or board out-of-pocket, Medicaid pays the facility directly through a combination of federal match, state share, and the resident's own income (their Patient Liability, sometimes called share-of-cost or PT).

Federal law requires that the resident retain a small portion of their income each month for personal expenses, clothing, toiletries beyond what the facility provides, telephone bills, hair care, snacks, magazines, transportation for outings. This protected amount is the Personal Needs Allowance, and it's deducted from the resident's gross income before the Patient Liability calculation.

Without a PNA, a resident's entire SSI/Social Security/pension check would flow to the facility, leaving them with nothing for personal dignity, choice, or quality of life.

The PNA is mandatory under 42 USC § 1396a(q) and 42 CFR § 435.725(c)(1). The federal floor is $30 per month, and has been since the Omnibus Budget Reconciliation Act of 1987 (P.L. 100-203, effective July 1988). It has never been indexed for inflation, never raised by Congress in nearly 40 years.1

States may set their PNA above the federal floor. Ohio's $75/month is 2.5x the federal floor.1

2026 Ohio Medicaid Personal Needs Allowance Numbers, All Settings

Why Ohio Raised It $50 to $75 (and Why ALW Was Left Out)

The $50 to $75 increase was originally written into Ohio's FY26-27 biennial budget, HB 96 of the 136th General Assembly. The General Assembly passed HB 96 in summer 2025 with the PNA increase included.1

Governor Mike DeWine line-item vetoed the budget language that would have implemented the increase. The veto was procedural rather than substantive, the Governor and ODM were aligned on raising the PNA, but the budget bill structure would have triggered retroactive payments to facilities and residents in a way that ODM judged administratively unworkable.

Following the veto, Governor DeWine directed the Ohio Department of Medicaid (ODM) to implement the increase via administrative rulemaking. ODM amended OAC 5160:1-6-07, and the amended rule carrying the $75 figure took effect January 1, 2026.1

A caution, because this trips people up: the current rule page also displays the date October 1, 2025 in places. Those are incorporation-by-reference dates for the federal materials the rule adopts (20 CFR 416.1157 and SSA § 1612(b)), not the date the PNA changed. The immediately prior version of the same rule, effective June 1, 2025, still read "fifty dollars," and the rule's list of prior effective dates runs to 6/1/2025 with no October 2025 entry. So a patient-liability calculation for any month before January 2026 correctly used $50, not $75.1

Why the statute (ORC § 5163.33) wasn't amended: ORC § 5163.33(B) reads that the PNA shall be "not less than fifty dollars for an individual resident and not less than one hundred dollars for a married couple if both spouses are residents of a nursing facility." That's a statutory floor, not ceiling, ODM has authority to set the operational figure higher under OAC. The $50 statutory floor remains, even though the operational figure is now $75. A future ODM Director could lower the PNA back to $50 by rulemaking without legislative action.1

Why ALW residents were left out: The administrative-rule pathway updated only OAC 5160:1-6-07, the post-eligibility rule for people in medical institutions. The Assisted Living Waiver runs on a different structure entirely: under OAC 5160-33-03 an ALW resident's room-and-board charge is capped at the SSI federal benefit rate minus fifty dollars, and it is that fifty-dollar gap, not a PNA rule, that leaves the resident a monthly cushion. Nothing in the nursing-facility amendment touched it, so ALW participants still end up with $50/month while a nursing facility resident now keeps $75.2

The Ohio Aging Advocacy Coalition flagged this gap publicly: "the rule applies only to individuals residing in medical institutions… This definition does not appear to include residents of assisted living facilities." LeadingAge Ohio echoed the concern in its member bulletin. Advocates expect ODM to address ALW PNA equity in a future rulemaking, but as of May 2026 no proposed rule has been published.

Practical implication for families: if your loved one is choosing between a nursing facility (where they'd get $75 PNA) and an Assisted Living Waiver placement (where they'd get $50 PNA), this $25/month difference is one minor factor among many, but it's worth knowing and asking about.1,2

The Resident Trust Fund: How Your Money Is Held

When a Medicaid resident keeps their $75 PNA, the facility must administer those funds in compliance with both federal law (42 CFR § 483.10(f)(10)) and Ohio rules (OAC 5160-3-16.5).1

Federal requirements (42 CFR § 483.10(f)(10))

The facility:

• May not require residents to deposit personal funds with the facility, but must hold and safeguard them if asked in writing.
• For Medicaid residents: any balance over $50 must go in a separate interest-bearing account (versus the $100 threshold for non-Medicaid residents).
• Pooled trust accounts are permitted, but must include separate accounting for each resident.
• Must provide quarterly statements showing all deposits, withdrawals, and the running balance.
• Must notify the resident when their balance approaches the resource limit (in Ohio, $2,000 for ABD/LTC eligibility).5
• Must convey funds and a final accounting to the resident's estate within 30 days of death or to the resident within 30 days of discharge.
• Must purchase a surety bond sufficient to recover all resident funds if the facility were to default.

Ohio-specific requirements (OAC 5160-3-16.5)

OAC 5160-3-16.5 mirrors and extends the federal rule:

• Surety bond must cover the full deposit balance plus interest plus refundable deposits. FDIC insurance alone is NOT acceptable.
• Quarterly statements must be issued within 30 days of quarter end documenting all financial transactions on the resident's account.
• All interest earned on the account is credited to the resident; pooled-account interest is prorated by each resident's share.
• Balances over $50 must be deposited in an interest-bearing account within 5 banking days.1
• Resident signature is required on every PNA disbursement receipt; if an "X" mark is used, two persons must witness.
• On death of a resident: within 60 days, if an estate has been opened in probate, the facility must transfer the balance and final accounting to the executor or administrator. After 60 days without estate action, the facility must transfer all remaining PNA funds to ODM (subject to estate recovery, or to fund unpaid funeral/burial expenses).
• On discharge: facility must release all of the resident's funds (up to the resource limit) to the resident; the facility cannot withhold for facility-imposed debts.

Practical advice

• Demand the quarterly statement. Don't wait, facilities often fail to send statements proactively. Ask in writing every quarter.
• Track the balance alongside the resident's other assets (countable cash, checking, savings). Total countable resources must stay below $2,000.5
• Reconcile the statement against your records of authorized purchases. Any discrepancy is potentially misappropriation.
• If the resident is moved temporarily (hospital stay, leave of absence), the trust account must remain, the facility cannot close it just because the resident is briefly absent.
• At discharge to home, another facility, or death, demand the final accounting in writing and retain it for at least seven years.

Patient Liability, Where the PNA Fits in the Math

For an institutional Medicaid resident in Ohio, the Patient Liability (PL), what the resident contributes to the facility from their income, is calculated under OAC 5160:1-6-07 in this order:

1. Gross income (Social Security, pension, annuity, VA, alimony, etc.)
2. Minus the exclusions at OAC 5160:1-6-07(I)(2), which include a VA pension of up to $90/month for a qualifying veteran or surviving spouse at (I)(2)(j)1
3. Minus the Personal Needs Allowance (PNA): $75/month1
4. Minus the Earned Income Allowance ($65), only if the resident has earned income (e.g., from supported employment)
5. Minus the Community Spouse Monthly Income Allowance (CSMIA) / MMMNA, for residents with a spouse still living in the community
   • Ohio uses the federal band: floor $2,705.00/month (effective 7/1/2026-6/30/2027), ceiling $4,066.50/month (effective 1/1/2026). Every community spouse is brought up to at least the floor; the ceiling caps an increase for excess shelter costs that most never reach.6,5
6. Minus dependent family allowances if the resident has a minor child or disabled adult child living with the community spouse
7. Minus health-care costs, current Medicare Part B premium, Medigap premium, Part D premium (if not auto-paid via LIS), and out-of-pocket non-covered medical costs
8. Minus QIT (Miller Trust) administration fees paid to a trustee or attorney. The parallel HCBS rule, OAC 5160:1-6-07.1, caps these at $15/month; ask your CDJFS what the institutional calculation allows.2
9. = Patient Liability (paid to facility each month as the resident's contribution to cost of care)

The facility then receives the Patient Liability + the Medicaid daily rate x days in month to cover total cost of care.

Quick example

• Mary lives in an Ohio NF. She receives $1,800/month Social Security, $400/month from a small private pension, no earned income, no community spouse, no dependents, and pays the current Medicare Part B premium.
• Gross income = $2,200
• Minus PNA ($75) = $2,125
• Minus Medicare Part B premium (verify current-year amount at medicare.gov)
• Patient Liability = the remainder, paid to the facility monthly
• Mary keeps $75/month in her Resident Trust Fund1

If Mary's husband Bob were still living at home as her community spouse and his only income was $1,200/month Social Security, Mary's MMMNA / CSMIA deduction would shift money to Bob until he reached the $2,705.00/month floor, drastically reducing her Patient Liability.6,5

HCBS Waiver Maintenance Allowances (PASSPORT, ALW, Ohio Home Care, MyCare)

When a Medicaid recipient lives in their own home or apartment under an HCBS waiver instead of in a nursing facility, the post-eligibility income calculation is fundamentally different, they have their own rent/mortgage, food, utilities to pay, so they need to retain far more of their income.

The HCBS post-eligibility rule is OAC 5160:1-6-07.1 (effective June 1, 2025). It governs PASSPORT, Ohio Home Care, MyCare Ohio HCBS, and the SAME-PACE program.

SIMNA, Special Individual Maintenance Needs Allowance

For PASSPORT and Ohio Home Care participants, the SIMNA is defined as 65% of the special income level:3

• 2026 Special Income Level (300% SSI FBR) = $2,982/month
• 2026 SIMNA = 65% of $2,982, which ODM publishes in MEPL 191 as $1,939/month, carrying the 65% product up to the whole dollar. The published figure, not the raw arithmetic, is what your county budgets against.3

This is the amount the participant retains for living expenses, rent/mortgage, utilities, food, transportation, plus personal items. It is structurally distinct from the institutional $75 PNA.3

How it works in practice

A PASSPORT participant with monthly income of $2,500 and a SIMNA of $1,939 would have:3

• Income above SIMNA: $2,500 - $1,939 = $561 patient liability paid to the waiver-service provider (PASSPORT case management contractor, or HCBS provider)
• Plus deductions for Medicare premium, Part D premium, etc., reducing patient liability further

If the participant's income is BELOW the SIMNA ($1,939), patient liability = $0, but they still must meet financial eligibility (countable income ≤ $2,982 SIL plus countable assets ≤ $2,000). The SIMNA is a post-eligibility deduction, not an eligibility threshold.3,5

Assisted Living Waiver, separate structure

The Assisted Living Waiver (ALW), governed by OAC Chapter 5160-33, uses a different math. Two separate rules do the work:

• Assisted Living Maintenance Needs Allowance (ALMNA) = the current SSI Federal Benefit Rate ($994/month for 2026), set by OAC 5160:1-6-07.1. This is the income the resident is allowed to keep in the post-eligibility calculation.
• Room and board is capped, not fixed: under OAC 5160-33-03 a provider may not charge more than the SSI benefit rate minus fifty dollars, so no more than $944/month in 2026.
• The $50/month difference is the resident's personal cushion, and it is the figure that did NOT rise to $75 in the nursing-facility rulemaking. Note that this is lower than the $75 a nursing facility resident keeps.2

ALW residents are responsible for room-and-board out of their personal income; Medicaid covers only the service component (assistance with ADLs, medication management, social services, transportation). This is structurally similar to NF, but the personal-allowance figure differs.

Next Generation MyCare

On January 1, 2026, the Ohio Department of Medicaid rolled out Next Generation MyCare in 29 Ohio counties and is expanding it to the rest of Ohio from April 1 through August 1, 2026. Next Gen MyCare is the integrated Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) architecture for full-benefit dual-eligibles age 21 or older that replaced the Medicare-Medicaid Plan (MMP) demonstration. Despite the integrated managed-care delivery, post-eligibility income treatment doesn't change. What the member keeps is set by where they live, not by the plan: an institutional MyCare member still retains the $75 PNA, and a MyCare member living in the community on the waiver still retains the SIMNA of $1,939/month, exactly as they would under fee-for-service Medicaid. A MyCare member receiving waiver services in an assisted living facility is the exception, they get the ALMNA (the $994 SSI benefit rate) rather than the SIMNA, per OAC 5160:1-6-07.1(K)(3)(b).7,3

Allowable and Prohibited Spending

CMS guidance in the State Operations Manual (SOM) Appendix PP (the federal manual surveyors use to assess NF compliance) and Ohio's OAC 5160-3-16.5 establish what residents may use PNA for and what facilities may NOT charge against PNA.1

Appropriate PNA spending

• Clothing, shoes, undergarments, outerwear
• Toiletries beyond facility-supplied basics, preferred soap, shampoo, lotion, toothpaste brands
• Hair care, salon, barber, perms, color, manicures
• Snacks, treats, vending purchases, restaurant meals during outings
• Reading materials, books, magazines, newspapers
• Telephone, postage, stamps, greeting cards
• Transportation for community outings, family visits
• Hobby and craft supplies, knitting, painting, puzzles, model-building
• Cable, internet, streaming subscriptions beyond what facility provides
• Religious and cultural items, prayer beads, devotional materials, ceremonial supplies
• Personal electronics, phone, tablet, e-reader, headphones
• Gifts for grandchildren, family, friends, birthdays, holidays
• Co-pays for OTC medications the facility doesn't cover
• Dental and vision co-pays for non-covered items (e.g., upgraded eyeglass frames)

Items the facility MUST provide (and cannot charge against PNA), under 42 CFR § 483.10(g)(8)

• Basic personal hygiene items, soap, shampoo, toothbrush, toothpaste, toilet paper (basic level)
• Room maintenance, housekeeping, laundry of bed/bath linens and personal clothing (at basic level)
• Nursing services, direct care, medication administration
• Dietary services, meals, snacks during scheduled times, special dietary needs
• Social services, care plan meetings, ombudsman access
• Activities, facility-sponsored programming
• Therapy services, physical, occupational, speech (when ordered)
• Medical equipment provided by Medicaid, wheelchairs, walkers, hospital beds (if part of plan of care)

If the facility charges PNA for any item in the second list without resident written consent, that's a federal violation triggering F-tag F570 or F571 during a state survey.

Working Residents, The Extra $65 Earned-Income Deduction

A few NF residents work, typically through supported employment programs, sheltered workshops (less common since the DOJ Olmstead-era enforcement), or part-time community jobs. For these residents, OAC 5160:1-6-07(I)(3) allows an additional $65/month earned-income deduction before Patient Liability is calculated.1

This means a working NF resident effectively retains:

• $75 PNA
• Plus up to $65 of earned income, which is the whole of the earned-income deduction the rule provides1

Read that ceiling literally. The rule allows a deduction of up to sixty-five dollars from earned income and no more; earnings above $65 are not partially protected by this deduction.1

For example: NF resident Tom earns $400/month from a part-time community job.

• $400 - $65 (the maximum deduction) = $335 of earned income that stays in the Patient Liability calculation
• Plus $75 PNA
• Tom keeps $75 (PNA) + $65 (deducted earned income) = $140/month1

This is one of the few areas where Ohio's PNA structure rewards residents for working, however modestly.

VA Pension + PNA = $165/Month Stack

Veterans receiving VA pension (the needs-based benefit, distinct from VA disability compensation) face a special rule when admitted to a Medicaid-paying nursing facility.

The $90 federal cap

Under 38 USC § 5503(d)(2) and the implementing regulation 38 CFR § 3.551(i): A single veteran with no spouse/child receiving Medicaid NF care has their VA pension capped at $90/month for the duration of the Medicaid placement, beginning the month after admission.4

The statute also bars the facility's Medicaid reimbursement from being reduced by the $90 retained pension, meaning the $90 stays with the veteran rather than flowing to the facility.4

How Ohio handles it: OAC 5160:1-6-07(I)(2)(j)

Ohio's own post-eligibility rule settles this, and the answer is in the order of the steps. OAC 5160:1-6-07(I) runs the patient-liability calculation in sequence: (I)(1) start from total gross monthly income, (I)(2) exclude a list of payments, then (I)(3) subtract the $75 PNA. Paragraph (I)(2)(j) puts the pension on that exclusion list: "Veterans administration pensions, including payments for aid and attendance, up to the amount of ninety dollars per month, paid to veterans or their surviving spouse, if any, who are residing in a nursing facility or are receiving HCBS waiver services."1

Because the $90 comes out at step (I)(2), before the PNA step, the $75 at (I)(3) is subtracted from the resident's other income rather than from the pension. The two genuinely stack:1

• $90/month VA pension, excluded at (I)(2)(j) before patient liability is figured4
• Plus $75/month Ohio PNA, deducted at (I)(3) from the resident's remaining income
• = $165/month in stacked personal funds4,1

Two limits on that $165 are worth knowing before you plan around it. The rule's exclusion reaches only (i) a veteran without a spouse or dependent minor or disabled child and (ii) a veteran's surviving spouse without a dependent minor or disabled child, so a surviving spouse drawing the pension qualifies on the same terms the veteran would. And the $165 assumes the resident has at least $75 of income besides the pension. A resident whose only income is the capped $90 pension keeps $90, because the PNA step has nothing left to subtract from.1

For married veterans

The math differs if the veteran has a community spouse or dependent, the VA pension may not be capped at $90, depending on the family circumstances and the type of pension (Improved Pension, Aid and Attendance, Housebound), and Ohio's (I)(2)(j) exclusion does not reach a veteran who has a spouse or a dependent minor or disabled child. Veterans should consult both their VA Vocational Rehabilitation/Veteran Service Officer AND a Medicaid eligibility caseworker, VSO referrals are available through every Ohio County Veterans Service Office.4,1

When PNA Balance Approaches the $2,000 Asset Limit

A Medicaid resident's countable resources must remain at or below $2,000 (single applicant) or $3,000 (married couple, both applying).5

The PNA is held in the Resident Trust Fund. The trust fund balance counts toward the $2,000 asset limit, it's not a sheltered "Medicaid-exempt" account. When the balance grows, the resident risks losing eligibility for excess resources.5

The arithmetic

A resident keeping the full $75 PNA without spending accumulates $900/year. From a zero balance, the balance passes $2,000 in the 27th month (roughly 2.2 years) at that pace.1,5

The federal rule

42 CFR § 483.10(f)(10)(iii) requires the facility to notify the resident in writing when their personal-funds balance approaches the resource limit. Ohio's OAC 5160-3-16.5 codifies this as a duty of the facility.

Practical strategy for families

• Don't let PNA accumulate, spend it monthly. The PNA is "use it or count it", unspent funds count as resources.
• Plan ahead, quarterly review with the facility administrator to track balance growth.
• Acceptable spend-downs:
  • Replacement clothing, shoes, undergarments
  • Hair care, salon, manicures
  • Pre-paid burial contract (irrevocable, exempt asset)
  • Dental work not covered by Medicaid
  • New eyeglasses or hearing aids beyond Medicaid coverage
  • Larger one-time purchases, wheelchair upgrades, recliner for the resident's room
  • Family gifts at birthdays/holidays (modest, documented)
• NOT allowable spend-down moves:
  • Cash withdrawals to family members (these are gifts subject to 60-month lookback divestment penalties)
  • Paying off third-party debts not legally owed by the resident
  • "Savings for after discharge", Medicaid can recover the funds in estate recovery if resident dies before spending

If the facility fails to notify and the balance crosses $2,000, the resident may face a Medicaid suspension or eligibility review by the County Department of Job and Family Services (CDJFS). This is rarely catastrophic, once spent down to under $2,000, eligibility resumes, but it can create a coverage gap of one or two months.5

Death of a Resident, Where the Money Goes

When a Medicaid NF resident dies, the Resident Trust Fund balance becomes part of their estate, and Ohio's expansive estate recovery program may attempt to claw it back.

Federal procedure (42 CFR § 483.10)

Within 30 days of death, the facility must convey the resident's personal funds and a final accounting to the resident's estate (executor or administrator).

Ohio-specific procedure (OAC 5160-3-16.5)

OAC 5160-3-16.5 sets a more granular procedure:

• Within 60 days of death: if a probate estate is opened, the facility transfers the funds and final accounting to the executor/administrator.
• After 60 days without estate action: the facility transfers all remaining PNA funds directly to ODM, subject to estate recovery (or to fund unpaid funeral/burial expenses).

Estate recovery interaction

Ohio is among the most aggressive estate-recovery states (see our Ohio Estate Recovery deep guide for full detail). PNA balances, like any other asset in the resident's estate, are subject to recovery for Medicaid services correctly paid for residents 55+ who received any Medicaid services, or for any-age permanently institutionalized recipients.8

Practical effect: Ohio elects expanded estate recovery, reaching non-probate assets as well as probate ones, so do not assume a small balance is out of reach.8 What a modest PNA balance may do is qualify the estate for one of Ohio's abbreviated probate routes, which change how the estate is administered rather than whether ODM may recover. Two Ohio probate statutes set the relevant dollar thresholds (verify current figures against the Ohio Revised Code text linked below):

• ORC § 2113.031, Summary Release from Administration: available for estates at or below the lesser of the statutory amount or the amount of funeral/burial expenses, with a higher threshold for a surviving spouse.
• ORC § 2113.03, Release from Administration: available for estates at or below the statutory amount, with a higher threshold for a full transfer to a surviving spouse.

Do not read either release as a bar on recovery. ODM still presents its claim through the ORC 2117.061 notice procedure, and any waiver is discretionary, so treat a claim as expected and ask an elder-law attorney or legal aid before you respond.8

What families should do

1. Open the probate estate within 60 days of death if there are any other assets (real property, bank accounts, vehicles).
2. Request the facility's final PNA accounting in writing within the first 30 days.
3. Check ODM 07400 procedural compliance, if the personal representative was unaware of the requirement to file the Medicaid Estate Recovery Information Notice, get an attorney involved promptly (see ORC § 2117.061).
4. For PNA balances under the small-estate threshold, work with Pro Seniors Inc., legal aid, or an elder-law attorney before responding to any AG claim, discretionary waivers are frequently granted.

Power of Attorney, Guardianship, and Resident Representative Rules

When a Medicaid NF resident lacks capacity to manage their own funds, the question of who controls the PNA becomes legally serious.

Federal "resident representative" rule (42 CFR § 483.10(b))

The federal NF rights regulation defines the resident representative as someone who has been appointed by the resident or by law to act on their behalf. This includes:

• A person designated by the resident through a written delegation (e.g., a financial Power of Attorney).
• A court-appointed guardian (or, in Ohio, a guardian of the estate).
• A family member exercising rights chosen by the resident.

The resident representative may exercise the resident's rights, including PNA spending decisions, to the extent allowed by state law. Importantly, the resident retains the right to revoke the representative if competent.

Ohio guardianship law (ORC Chapter 2111)

Under Ohio law, a guardian of the estate (also called a "guardian of the person and estate" if the same person serves both functions) has fiduciary authority over the ward's financial assets. The guardian:

• Must act for the ward's benefit, using PNA only for the ward's needs and quality of life.
• Must keep accurate records, every disbursement, with supporting documentation.
• Must file annual accounts with the probate court (ORC § 2109.30).
• Cannot use PNA for guardian's personal benefit without specific court approval.
• Misuse can constitute breach of fiduciary duty subject to surcharge, removal, and potentially criminal charges.

Ohio Power of Attorney law (ORC Chapter 1337)

The Ohio Uniform Power of Attorney Act (UPOAA) governs financial Powers of Attorney. The agent under POA:

• Owes fiduciary duty to the principal (the resident).
• Must act in good faith and in the principal's best interest (ORC § 1337.34).
• Must keep records of all transactions for the principal.
• Cannot self-deal or use principal's funds for personal benefit (ORC § 1337.36(b)) without specific authorization in the POA document.
• Liability for breach can include surcharge and removal.

Family member exercising rights

If a resident has neither a guardian nor a POA, the facility may treat a family member as the resident representative if the resident verbally designates them or the family member signs paperwork on the resident's behalf with apparent acquiescence. This is a fragile arrangement, without a written designation, conflicts among family members can paralyze decision-making.

Misuse and recovery

If a guardian, POA agent, or family representative misuses PNA funds:

• Civil: action under ORC Chapter 1337 (POA) or 2109 (guardianship) for surcharge.
• Criminal: misappropriation under ORC § 3721.21 (theft from elder), ORC § 2913.02 (theft) potentially elevated to ORC § 2913.61 (theft against elderly persons).
• Adult Protective Services: ORC § 5101.61 mandatory reporting for suspected exploitation.
• Long-Term Care Ombudsman: Ohio Long-Term Care Ombudsman (1-800-282-1206) accepts complaints and refers to investigation agencies.9

Families should choose representatives carefully and ensure quarterly statement reviews include a third party (another family member, attorney, or accountant) when possible.

ICF/IID Residents

ICF/IID stands for Intermediate Care Facility for Individuals with Intellectual Disabilities. ICF/IID is a separate facility category from NF, governed by different licensure rules but parallel post-eligibility income treatment.

Statutory floor

ORC § 5163.33(B), (C) sets the same statutory floor for ICF/IID as for NF: not less than $50 individual / not less than $100 for a couple both residing in the facility. The administrative-rule increase to $75 effective January 1, 2026 applies to residents of medical institutions under OAC 5160:1-6-07; whether the increase extended administratively to ICF/IID is governed by OAC 5123-7-09 (the parallel ICF/IID PNA rule). Families should confirm the operational ICF/IID PNA figure with the Ohio Department of Developmental Disabilities (DODD) before relying on a specific dollar amount.1

Accountability

ICF/IID PNA accounts follow the same federal rules under 42 CFR § 483.10(f)(10), with state oversight by DODD rather than ODH. Quarterly statements, surety bond, and resident signature requirements apply.

Practical reality

ICF/IID residents are typically adults with intellectual disabilities who have lived in the facility for many years; many have a court-appointed guardian (often a parent or sibling, sometimes a county developmental disabilities board representative). PNA management is therefore especially important, these residents may have limited capacity to advocate for themselves on personal-funds disputes.

The Federal $30 Floor and the PNA Modernization Act

The federal floor of $30/month under 42 USC § 1396a(q) was set by OBRA-87 (P.L. 100-203, effective July 1988). It has never been raised in nearly 40 years. In 1988, $30 had the purchasing power of approximately $80 in 2026 dollars (per the U.S. Bureau of Labor Statistics CPI inflation calculator), a decline of roughly 60% in real value.1

Every state must set its nursing-facility PNA at or above that $30, and each state sets its own amount by its own statute or rule, on its own schedule. Ohio's $75 is 2.5 times the floor. If you need another state's current figure, confirm it with that state's Medicaid agency rather than relying on a national chart, which can be a year or more out of date.1

PNA Modernization Act, federal legislation pending

Members of Congress have introduced legislation multiple sessions to raise the federal floor:

• HR 3853 (116th Congress, 2019), Rep. Jan Schakowsky (D-IL), would raise federal floor from $30 to $50.
• HR 7682 (118th Congress, 2023-24), Rep. Schakowsky and others, would raise federal floor $30 to $60 individual / $60 to $120 couple.
• HR 5685 (119th Congress, 2025-26), currently pending, same modernization structure as HR 7682; sponsored by Rep. Schakowsky.1

The PNA Modernization Act (in any form) has not received a committee markup in any of its three iterations. It is endorsed by Justice in Aging, Consumer Voice for Quality Long-Term Care, and AARP. National Association of Medicaid Directors (NAMD) has not formally taken a position. Provider trade associations (American Health Care Association, LeadingAge) have generally supported the bill but not actively lobbied.

What it would mean for Ohio

If HR 5685 (or a successor bill) became law and raised the federal floor to $60: Ohio's $75 already exceeds the new floor, so no immediate change.1

If a future bill raised the floor to $100: Ohio would need to amend ORC § 5163.33 or OAC 5160:1-6-07 to comply. Currently the operational PNA is $75, with the statutory floor at $50.1

Ohio PNA History 1988 to 2026

A future ODM Director could increase or decrease the operational PNA without legislative action, so long as the figure stays at or above the statutory floor of $50. There is no scheduled review or sunset provision in OAC 5160:1-6-07.1

Where to Get Help When PNA Is Mishandled

If you believe a facility, guardian, or agent has misappropriated a resident's Personal Needs Allowance, the following Ohio and national resources can investigate, mediate, or take legal action.

Additional regional legal-aid offices serve specific parts of the state: Legal Aid Society of Cleveland (216-687-1900), Legal Aid of Western Ohio in the Toledo region (419-724-0030), Southeastern Ohio Legal Services (800-686-3668), and Community Legal Aid Services covering Akron, Canton, and Youngstown (800-998-9454).

Three Worked Examples

The names and incomes below are illustrative hypotheticals, not real individuals; use them to see how the math works, not as a substitute for your own eligibility determination.

Example 1: Lillian, Cuyahoga County, age 82, full Medicaid NF resident

• Income: $1,400/month Social Security, $200/month from a small CWA pension, no earned income, no spouse, no dependents
• Pays the current Medicare Part B premium
• 2026 NF PNA: $75/month
• Patient Liability calculation:
  • Gross income $1,600
  • Minus PNA ($75) = $1,525
  • Minus current Medicare Part B premium (verify amount at medicare.gov)
  • Patient Liability is the remainder, paid to the facility each month
• Resident Trust Fund: facility maintains an interest-bearing account for Lillian; $75 deposited monthly
• Lillian uses her PNA for clothing, hair care, magazine subscriptions, holiday gifts for grandchildren, and birthday outings to a local restaurant
• Quarterly statements arrive by mail; her daughter (resident representative under POA) reviews each one
• Balance has averaged $200-$400 over the year (Lillian spends down most months, occasionally accumulates for a larger purchase)1

Example 2: Marcus, Stark County, age 67, ALW participant in Canton

• Income: $1,300/month Social Security, no other income, no spouse, no dependents
• Pays the current Medicare Part B premium
• 2026 ALW math:
  • SSI FBR = $994/month
  • ALMNA = $994, Marcus's eligible monthly maintenance need
  • Of that, $944 = room-and-board paid to AL provider
  • $50 = Marcus's cushion after room and board (NOT $75, the ALW was not part of the nursing-facility increase)
• Two payments, not one: room and board of no more than $944 goes to the AL provider, and Marcus's income above the $994 ALMNA ($1,300 - $994 = $306, less his Medicare Part B premium) is his patient liability toward the cost of waiver services2

This is the gap, Marcus would benefit from a $25/month PNA equity raise if Ohio extended the increase to ALW. Advocates expect this fix in a future ODM rulemaking.2,1

Example 3: Rita, Lucas County, age 76, dual-eligible, on PASSPORT Waiver living in own home in Toledo

• Income: $2,400/month Social Security + small annuity payments
• 2026 SIL = $2,982; PASSPORT financial eligibility met (income < $2,982; assets < $2,000)
• 2026 SIMNA (PASSPORT post-eligibility) = 65% of $2,982, published by ODM as $1,939
• Patient Liability calculation:
  • Income above SIMNA: $2,400 - $1,939 = $461
  • Minus current Medicare Part B premium
  • Patient Liability is the remainder, paid to the PASSPORT case management contractor
• Rita keeps $1,939/month for her rent ($600), utilities ($150), groceries ($300), prescriptions, transportation (medical and otherwise), and personal care needs
• This contrasts sharply with NF math, Rita keeps over $1,800 more per month at home than she would in a nursing facility, which is why HCBS waivers are vastly preferred when feasible3,5

10 Ohio-Specific PNA Pitfalls

1. The $50 ALW PNA gap: don't assume your loved one in an Assisted Living Waiver setting will see the new $75 PNA. Verify with the AL facility that the $50 figure still applies as of 2026.2
2. PNA accumulation triggering Medicaid review: balance of $1,800+ in trust fund + $300 in checking + $100 in savings can push a resident over the $2,000 asset limit. Spend monthly.5
3. VA pension stacking confusion: if a caseworker deducts the $90 from the $75 PNA, point them to OAC 5160:1-6-07(I)(2)(j), which excludes the pension one step before the PNA is subtracted. That ordering is what makes $90 + $75 stack.4,1
4. Quarterly statement neglect by facilities: don't wait. Demand it within 30 days of each quarter end (Mar 31, Jun 30, Sep 30, Dec 31).
5. Earned-income deduction overlooked: if your loved one works (even a part-time community job), the $65 earned-income deduction is often missed by caseworkers. Push for it on the next eligibility review.1
6. PNA at death, 60-day estate window: if no probate estate is opened within 60 days, ODM gets the funds. Open the estate promptly even for small balances.
7. POA and guardian misuse: Ohio's Uniform POA Act (UPOAA, ORC Ch. 1337) creates strict fiduciary duty. Document every PNA spending decision in writing.
8. Facility-imposed fees against PNA: items the facility must provide free under 42 CFR § 483.10(g)(8) cannot be charged to PNA. Common over-charges: special diet supplements, premium hygiene items, "facility-provided" social activities.
9. Resident has accumulated more than $2,000: spend down to under $2,000 within 30 days; the resident remains eligible if spend-down occurs in same month as notice. Don't gift to family, gifts trigger 60-month lookback divestment penalties.5
10. No quarterly statements at all: facility surveyors rarely cite this absent a complaint. If statements are missing, file with ODH-ANM Program and the Long-Term Care Ombudsman.

Pending Policy Watch

1. PNA Modernization Act HR 5685 (119th Congress), pending in House Energy & Commerce. Would raise federal floor $30 to $60 individual / $60 to $120 couple. Has not received committee markup.
2. Ohio ALW PNA equity, advocates (Ohio Aging Advocacy Coalition, LeadingAge Ohio) pushing ODM to extend the $75 PNA to Assisted Living Waiver. No proposed rule as of May 2026.
3. Ohio ICF/IID PNA confirmation, operational figure for 2026 should be confirmed with DODD; ORC § 5163.33 statutory floor is $50.
4. Next Generation MyCare statewide rollout, phased in over 2026 (29 counties from Jan 1, 2026; the rest of Ohio from April 1 through August 1, 2026). PNA structure unchanged.7
5. Federal home equity cap freeze under Pub. L. 119-21 (OBBBA, 7/4/2025), effective 1/1/2028; doesn't directly affect PNA but does affect overall LTC eligibility math.
6. Group VIII Work-Engagement 1115 demonstration, Ohio submitted 2/28/2025; status pending CMS approval; doesn't affect NF/HCBS waiver populations directly.

Learn More

Find personalized help navigating Ohio Medicaid 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.