A Pennsylvania resident on nursing-facility Medicaid keeps $60 of their monthly income in 2026 for personal use instead of turning all of it over to the cost of care. That protected slice is the Personal Needs Allowance (PNA), guaranteed by federal and state law for items a Medicaid-certified nursing facility does not provide and Medicaid does not pay for. The $60 figure was raised from $45/month effective January 1, 2025, the first PNA increase in Pennsylvania since 2007.

The 2025 PNA increase is one of the most consequential, and underdiscussed, recent changes in Pennsylvania Medicaid policy affecting nursing facility residents. For tens of thousands of Pennsylvanians who live in Medicaid-certified nursing facilities at any given time, the PNA is the only money they have for the items that distinguish a meaningful life from an institutional one: a phone bill, a haircut, clothing replacement, denture cream, postage to send a birthday card, a weekly newspaper subscription, a small gift for a grandchild's birthday. The 33% increase from $45 to $60, while still well below what advocates argue is dignified, is the largest single-step PNA increase in PA's modern history.

This guide explains what the PNA is, what residents can use it for, how it interacts with other components of nursing-facility Medicaid (patient-pay obligation, Medicare premiums, MMNA deflection to community spouse, approved medical expenses), what the 2025 increase changed in practical terms, how Pennsylvania compares qualitatively to other states, what families should know about helping a loved one manage their PNA, and what advocacy efforts continue to push for further increases.

What the Personal Needs Allowance Is

The Personal Needs Allowance is a federally-mandated and state-administered protection for nursing-facility residents whose care is paid for (in part or in whole) by Medicaid. The mechanism:

  • A resident in a Medicaid-certified nursing facility owes a "patient-pay" amount each month, substantially all of their income, less specified deductions
  • Medicaid pays the difference between patient-pay and the facility's Medicaid per-diem rate
  • The PNA is one of the specified deductions: the resident keeps $60/month (in PA, 2026) for personal use that the facility does not provide and Medicaid does not cover

Why does this matter? Without the PNA, federal law would allow Medicaid to take essentially all of a resident's income, leaving them with nothing for the small purchases that make daily life tolerable. The PNA is the legal recognition that nursing-facility residents are still adults with personal preferences, social connections, and dignity needs that institutional care alone cannot meet.

The historical context. Pennsylvania set its PNA at $45/month in 2007 and held it there until the 2025 increase to $60. The increase, while welcomed, still leaves PA's PNA below what most cost-of-living analysts consider adequate for the items it is designed to cover.

What the PNA Can Be Spent On

The PNA is the resident's money. Residents may spend it on any legal personal need that the facility does not provide and that Medicaid does not cover. Common spending categories:

Personal care and grooming:

  • Haircuts and salon services (in-house facility salon services or outside barber visits)
  • Manicure, pedicure, beard trim
  • Hair-care products (shampoo, conditioner, styling products beyond facility-provided basics)
  • Cosmetics and personal-care products
  • Razors and shaving cream
  • Denture cleaning supplies and adhesive
  • Hearing-aid batteries (Medicaid does not typically cover ongoing batteries)
  • Eyeglass repair and replacement (frames; many states cover lenses but not frame replacement)

Communication:

  • Mobile phone monthly service
  • Landline service (if facility does not provide a private line)
  • Postage stamps for letter-writing
  • Note cards and stationery for correspondence

Clothing and apparel:

  • Replacement clothing (the facility provides basic items but not full wardrobe replacement)
  • Underwear, socks, slippers
  • Seasonal clothing (sweaters, lighter clothing for summer)
  • Shoes (Medicare may cover one pair of orthopedic shoes annually for diabetic residents but not general footwear replacement)
  • Clothing alterations and repair

Entertainment and engagement:

  • Newspaper or magazine subscriptions
  • Cable TV upgrades (basic cable is often facility-provided; premium channels or streaming services typically are not)
  • Streaming service subscriptions
  • Audiobooks and audio entertainment subscriptions
  • Modest entertainment items (puzzles, books, knitting supplies, art supplies)
  • Religious materials (prayer books, rosaries, religious art)
  • Music (CDs, downloads, online music subscriptions)

Social and family:

  • Gifts for grandchildren and other family members on birthdays/holidays
  • Greeting cards
  • Photographs or photo prints
  • Restaurant meals when on facility-organized outings
  • Pet-care contributions (some facilities allow modest pets; PNA can be used for pet supplies the facility doesn't cover)

Comfort and dignity:

  • Specific food items the facility doesn't provide (favorite snacks, ethnic foods, specialty items)
  • Comforter, decorative pillow, throw blanket for personal use
  • Religious items
  • Modest dental items (denture cream, tooth-whitening products)
  • Hair-care products specific to the resident's needs

Tobacco products (for residents who smoke and the facility permits), though many facilities are smoke-free.

What the PNA CANNOT Be Spent On

The PNA cannot be used to cover items that the facility is required to provide, OR items that Medicaid is required to cover. Residents who use PNA for these items are essentially throwing money away, they would receive these items free if they did not pay out of PNA.

Facility-provided items (resident does NOT need to pay):

  • Food and meals (standard nutrition)
  • Basic toiletries (soap, basic shampoo, basic toothpaste, basic toothbrush)
  • A single bed and basic bedding (linens, blankets, pillows, sheets)
  • Basic personal-care services (assistance with bathing, dressing, toileting, transferring, feeding)
  • Routine medical care
  • Laundry of facility-provided linens
  • Medical equipment that is part of standard care
  • Routine room cleaning

Medicaid-covered items (resident does NOT need to pay):

  • Most prescription medications (subject to Part D copays for dual-eligibles, and Medicaid covers Part D copays for QMB-eligible residents)
  • Durable medical equipment under the DME benefit (wheelchairs, walkers, oxygen concentrators, beds with medical features)
  • Medically-necessary dental services (subject to Pennsylvania's specific dental benefit definitions)
  • Hospital care
  • Physician visits
  • Lab and imaging
  • Mental health services covered under behavioral health carve-out

Common confusion: Some residents pay for items out of PNA that the facility actually provides. Talking to the facility's social-services or business-office staff to clarify what is provided saves PNA dollars for items the facility does NOT provide.

How the Pennsylvania Personal Needs Allowance Fits in the Patient-Pay Calculation

For a resident in a PA nursing facility receiving Medicaid:

Patient-pay formula: Monthly income − $60 PNA − Medicare Part B premium − Medicare Part D premium (varies by plan) − Medigap premium (when applicable) − Approved medical expenses (uncovered medical bills) − MMNA deflection to community spouse (when married) = Patient-pay obligation to facility

For 2026 federal Medicare premium figures, see medicare.gov/basics/costs.

Worked example: Single resident, PA, 2026.

Eleanor is a single resident at a Heritage Pittsburgh nursing facility on Medicaid. Her income (Social Security plus a small pension) sums to roughly $3,200/month. Her deductions include the $60 PNA, her Medicare Part B premium, a modest Medicare Part D premium, no MMNA (single), and no approved uncovered medical expenses. The resulting patient-pay liability is approximately $3,200 minus those deductions; Pennsylvania Medicaid pays the facility the difference between that liability and the facility's Medicaid per-diem rate. Eleanor retains the $60 PNA in a personal account at the facility, which she can spend on personal items.

Worked example: Married resident, PA, 2026.

Frank is in an Erie Heights nursing facility on Medicaid. His wife Hilda lives at home and qualifies for the MMNA. Frank's combined Social Security and pension income totals about $3,600/month. Frank's deductions include the $60 PNA, his Medicare Part B premium, a modest Medicare Part D premium, and a MMNA deflection to Hilda calculated under Pennsylvania's spousal-impoverishment framework. Pennsylvania's MMNA cap for 2026 is $4,066.50/month and the MMNA base is $2,643.75/month effective 7/1/2025-6/30/2026. The deflection amount fills the gap between Hilda's own income and her permitted MMNA. Frank's patient-pay equals income minus those deductions. Hilda receives the deflected portion (added to her own income); Frank retains the $60 PNA at the facility.

Critical point: The PNA is preserved BEFORE patient-pay is calculated. It is the resident's first deduction, not a discretionary allocation from patient-pay. Even residents whose income is just barely above the SIL get the full $60 PNA.

How the 2025 Increase Worked

The increase from $45 to $60, a 33% increase and the largest single-step PNA adjustment in Pennsylvania's modern history, was implemented effective January 1, 2025, through:

  • OLTL Operations Memorandum announcing the change to all 67 County Assistance Offices
  • Updated PA LTC Handbook Chapter 468.3 revising the PNA computation procedure
  • Direct CAO recalculation of every PA nursing-facility resident's patient-pay starting with January 2025 monthly billing cycles
  • Facility communication requiring nursing facilities to credit each resident's PNA account with the additional $15/month starting January 2025

For most residents, the change was automatic and seamless: starting with January 2025 statements, the resident's PNA deposit at the facility was $60 instead of $45. Patient-pay obligations decreased by $15/month for affected residents.

What changed for residents in practical terms. A $15 increase per month, $180 per year, sounds modest. In practical terms, for a resident already at $45, this puts an extra haircut, a monthly newspaper subscription, or a small monthly clothing item within reach without sacrificing other dignity purchases. For residents with chronic medical-supply needs not covered by Medicaid (denture adhesive, hearing-aid batteries, eyeglass repair), the additional $15 helps cover replacement costs that previously came at the expense of dignity items like haircuts and personal grooming.

How Pennsylvania's Personal Needs Allowance Compares Nationally

Pennsylvania's $60 PNA in 2026 places PA in the middle of the national distribution. Many higher-cost states have set their PNAs at or above $75. Some large-population states sit below $60. Pennsylvania's $60 is meaningfully better than the long-frozen PNAs in some peer states but still below the cluster of higher-PNA states.

What states do with higher PNAs: States with higher PNAs generally fund the difference through state-only Medicaid match contributions, the federal Medicaid program does not require states to set PNAs above the floor, but state legislatures may choose to do so as a recognition of dignity needs. The trade-off is that higher PNAs reduce facility Medicaid reimbursement (because patient-pay is lower) and increase state Medicaid expenditure to make facilities whole.

Why some states keep PNAs low. Where states have not raised PNAs for many years, the typical reason is budgetary: increasing the PNA would increase state Medicaid expenditure. PA's 2025 increase to $60 was supported by both LeadingAge PA (representing facilities) and PHLP (representing residents), the rare alignment of provider and resident interests on a Medicaid policy change.

For a state-by-state PNA comparison table, see Brevy's federal PNA hub, which aggregates per-state PNA figures sourced to each state's Medicaid handbook.

Practical Tips for PA Nursing Facility Residents and Families

1. Know what the facility is required to provide. Facility-provided items (food, basic toiletries, basic clothing replacement when items wear out, basic personal care, basic linens) should NOT come out of PNA. Talk to the social-services director or business-office manager to clarify what is provided.

2. Open a personal account at the facility OR outside. The PNA is the resident's money. The facility must allow either an in-house account (managed by the business office) or an outside bank account. In-house accounts are simpler for daily transactions; outside accounts give the resident full banking flexibility but require more management.

3. Track PNA spending. A simple notebook or spreadsheet helps the resident (or family member with power of attorney) see where the PNA goes each month. This identifies patterns: too much spent on one category, items the facility actually provides for free, opportunities to save for larger purchases.

4. Save toward larger purchases. The PNA can be saved across months for a larger purchase. A resident who saves $30/month for 6 months has $180, enough for new shoes, a small TV upgrade, a holiday gift package for grandchildren.

5. Watch for facility billing errors. Facilities are required to provide a monthly statement showing the resident's PNA deposit and any disbursements. Errors do happen; review statements monthly. The most common error is a facility charging the resident's PNA for items that should be facility-provided.

6. Use the PNA for items the facility doesn't provide. If the facility provides basic shampoo and basic toothpaste, don't pay for those out of PNA. If the resident wants a specific brand of shampoo or a specific toothpaste, paying out of PNA is the dignity choice.

7. Coordinate with family. Family members can supplement PNA with gift-giving but cannot deposit money into the resident's PNA account in a way that would count as the resident's resources for Medicaid eligibility purposes. Direct gifts (clothing, books, comfort items) are simpler and don't affect Medicaid eligibility.

8. Understand what happens to unspent PNA at death. Unspent PNA in the resident's facility account becomes part of the resident's probate estate at death. PA estate recovery applies (probate-only). Most residents leave behind very small balances. Family should plan for this in the broader estate-recovery context.

9. Help the resident articulate priorities. Some residents struggle to articulate what they want to spend the PNA on. Family members can help by talking through preferences (favorite foods, magazines they used to read, activities they enjoyed at home) and translating those into PNA-purchasable equivalents.

10. Advocate for further increases. Resident advocacy organizations (PHLP, LeadingAge PA, AARP Pennsylvania) continue to advocate for PNA increases beyond $60. Family members and residents can support these efforts by contacting state legislators, submitting public comment on PA budget hearings, and supporting elder-advocacy organizations financially.

Pending Policy Efforts

As of May 2026, no further PNA increase is pending in active PA legislation. The 2025 increase was implemented administratively by DHS rather than through statute, so further increases would similarly be DHS-administrative actions rather than requiring new legislation.

Active advocacy:

  • PHLP continues to advocate for ongoing PNA review with cost-of-living indexing
  • LeadingAge PA has signaled support for further PNA increases over the next few budget cycles
  • AARP Pennsylvania continues to support resident-dignity advocacy
  • Individual nursing-facility resident councils statewide engage in local advocacy

What would trigger further increase:

  • Legislative pressure (constituent contacts to state senators and representatives)
  • DHS budget allocation for additional PNA expansion
  • Federal floor increase (if Congress raises the floor, PA's PNA would move accordingly)
  • Peer-state PNA increases that put pressure on PA to keep pace

Eight Common PNA Pitfalls

  1. Paying for facility-provided items out of PNA. The most common error. Talk to the facility business office to clarify what is provided free.

  2. Not opening a personal account. Some residents leave their PNA in the facility's general resident-funds account without opening a specific account in their name. Federal nursing-facility rules require individualized accounts when requested.

  3. Family members making large gifts that count as resident resources. A $5,000 family gift deposited to the resident's account would count as the resident's resources, potentially triggering a resource-test failure. Direct gifts of clothing or comfort items are simpler.

  4. Not tracking PNA spending. Without monthly tracking, residents and families lose visibility into where the money goes. A simple notebook or spreadsheet solves this.

  5. Failing to review monthly facility PNA statements. Errors do happen. Review statements within 30 days of receipt; raise discrepancies immediately with the business office.

  6. Saving PNA aggressively without using it. Some residents accumulate PNA balances without using them, a sign that the resident is not using the funds for dignity items. Family members can help residents identify items they would actually use.

  7. Spending PNA on items Medicaid would cover. A resident paying out of PNA for prescription co-pays is throwing money away; most prescription co-pays are covered for QMB-eligible residents, and Medicaid covers most prescriptions for non-QMB residents.

  8. Not planning for unspent PNA at death. Unspent PNA is a probate asset subject to estate recovery. Residents who accumulate larger balances should be aware that unspent funds may be partially recovered by Medicaid through PA's probate-only estate-recovery process.

Frequently Asked Questions

Pennsylvania's PNA for nursing-facility residents is $60/month in 2026. It was raised from $45/month effective January 1, 2025, the first PNA increase in PA since 2007.

Residents of Medicaid-certified nursing facilities and ICF/ID facilities who are receiving Medical Assistance for their care. It does not apply to private-pay residents, residents in personal care homes paying privately, or residents on a Medicare-only short-term rehab stay.

Any personal need the facility does not provide and Medicaid does not cover: haircuts, clothing replacement, phone bills, postage, magazines, comfort foods, denture adhesive, hearing-aid batteries, gifts for family, religious items, modest entertainment subscriptions. You cannot spend it on items the facility is required to provide (basic toiletries, food, basic linens) or items Medicaid covers (most prescriptions, DME).

The PNA is the resident's first deduction from monthly income before patient-pay is calculated. Other deductions include Medicare premiums, approved uncovered medical expenses, and an MMNA deflection to a community spouse (if married). What remains is the resident's patient-pay obligation to the facility.

Pennsylvania sits in the middle of the national distribution. Many higher-cost states are at or above $75; some large-population states sit below. See Brevy's federal PNA hub for a state-by-state comparison sourced to each state's Medicaid handbook.

Where to Get Help

  • Facility Business Office. First stop for any PNA question; facility staff understand what the facility provides, how to set up resident accounts, and how to review monthly statements.
  • Pennsylvania Health Law Project (PHLP). 1-800-274-3258, free legal assistance with resident-rights issues including PNA disputes.
  • Pennsylvania Long-Term Care Ombudsman. 1-717-783-8975, investigates complaints from nursing-facility residents including allegations of misuse of resident funds.
  • PA Department of Human Services Office of Long-Term Living (OLTL). Operations questions about PNA computation and increases: 1-800-757-5042.
  • County Assistance Office. For patient-pay calculation questions: find your CAO via the PA DHS county-office locator.
  • AARP Pennsylvania. Advocacy questions and PNA-increase policy questions: 1-866-389-5654.
  • LeadingAge Pennsylvania. Provider-side resources: 1-717-763-5724.
  • Family Council / Resident Council at the nursing facility. Most facilities have resident-led councils that address quality-of-life issues including PNA management.

Learn More

Find personalized help navigating Pennsylvania's 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.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.