PA Personal Needs Allowance: The $60 Residents Keep (2026)

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. Pennsylvania raised the figure from $45 to $60 per month effective January 1, 2025.1

For the tens of thousands of Pennsylvanians who live in Medicaid-certified nursing facilities, the PNA is the money left for the items an institution does not cover: a phone bill, a haircut, replacement clothing, denture adhesive, postage, a magazine subscription, a small gift for a grandchild. The 2025 increase from $45 to $60 raised that monthly amount by $15.1

This guide explains what the PNA is, what residents can spend it on, how it fits the other pieces of nursing-facility Medicaid (the patient-pay obligation, Medicare premiums, the community-spouse allowance, approved medical expenses), what the 2025 increase changed, how Pennsylvania sits against the federal floor, and what families should know about managing a loved one's PNA.

Pennsylvania Personal Needs Allowance Snapshot

• Pennsylvania's PNA for nursing-facility residents is $60/month in 2026, raised from $45/month effective January 1, 2025.1
• Federal law sets a PNA floor of at least $30/month for an institutionalized individual, and states may set it higher. Pennsylvania's $60 is double the federal minimum.2
• The PNA applies to nursing-facility (NF) residents and residents of an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/ID) receiving Medical Assistance. It does not apply to residents in personal care homes paying privately, residents in Community HealthChoices (CHC) waiver community placements (different income-budgeting rules apply), or residents on a Medicare-only short-term rehab stay.
• What the PNA can be spent on: any personal need the facility does not provide and Medicaid does not cover, such as clothing replacement, haircuts and personal-care services, telephone, postage, magazines and newspapers, religious items, gifts for family, comfort foods, denture supplies, hearing-aid batteries, eyeglass repair, and modest entertainment subscriptions.
• What the PNA cannot be spent on: items the facility is required to provide (food, basic toiletries, a bed, basic linens, basic personal care) and items Medicaid covers (most prescriptions, durable medical equipment, medically necessary dental).
• Where the PNA fits in the patient-pay calculation: the resident's monthly income, minus the PNA ($60), minus health-insurance premiums, minus approved medical expenses, minus any Minimum Monthly Maintenance Needs Allowance (MMNA) deflected to a community spouse, equals the patient-pay liability owed to the facility.
• The PNA is the resident's money. It is deposited into a personal account at the resident's request, and residents have a federal right to access and spend it on their own choices, subject to facility policies on prohibited items.

What the Pennsylvania Personal Needs Allowance Is

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

• 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 that patient-pay amount and the facility's Medicaid per-diem rate.
• The PNA is one of the specified deductions: the resident keeps $60/month (in Pennsylvania, 2026) for personal use the facility does not provide and Medicaid does not cover.1

Without the PNA, federal rules would allow Medicaid to claim essentially all of a resident's income, leaving nothing for the small purchases of daily life. The PNA is the legal recognition that nursing-facility residents keep personal preferences, social connections, and needs that institutional care alone does not meet.

Federal law guarantees a floor: at least $30/month for an institutionalized individual, a minimum unchanged since it took effect in 1988. A state must set its nursing-facility allowance at or above that $30 and is free to set it higher, as Tennessee does at $70. Pennsylvania's $60 is double the federal floor.2

What the PNA Can Be Spent On

The PNA is the resident's money. Residents may spend it on any legal personal need the facility does not provide and Medicaid does not cover.1 Common categories:

Personal care and grooming:

• Haircuts and salon services (in-house or outside barber visits)
• Manicure, pedicure, beard trim
• Hair-care 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 frame replacement

Communication:

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

Clothing and apparel:

• Replacement clothing (the facility provides basic items, not a full wardrobe)
• Underwear, socks, slippers
• Seasonal clothing
• Shoes (Medicare may cover one pair of therapeutic 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 typically are not)
• Streaming and audiobook subscriptions
• Modest hobby items (puzzles, books, knitting or art supplies)
• Religious materials (prayer books, rosaries, religious art)
• Music (CDs, downloads, subscriptions)

Social and family:

• Gifts for grandchildren and other family members
• Greeting cards
• Photographs and photo prints
• Restaurant meals on facility-organized outings
• Pet-care contributions (where the facility permits modest pets)

Comfort and dignity:

• Specific food items the facility does not provide (favorite snacks, ethnic or specialty foods)
• A decorative pillow, throw blanket, or comforter for personal use
• Modest dental items (denture cream, whitening products)

Residents who smoke, at facilities that permit it, may use the PNA for tobacco products, though many facilities are smoke-free.

What the PNA Cannot Be Spent On

The PNA cannot be used to cover items the facility is required to provide or items Medicaid is required to cover. Residents who pay for these out of PNA are spending money on things they would receive for free.

Facility-provided items (resident does not pay):

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

Medicaid-covered items (resident does not pay):

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

A common error is paying out of PNA for items the facility actually provides. Asking the facility's social-services or business-office staff to clarify what is included preserves 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 Pennsylvania nursing facility on Medicaid, the patient-pay obligation is the resident's monthly income reduced by a defined stack of deductions. The PNA is the first of those deductions.

The standard Medicare Part B premium is $202.90/month in 2026, deducted from income before patient-pay is set.3 Pennsylvania Medicaid then pays the facility the difference between the resident's patient-pay and the facility's Medicaid per-diem rate. For 2026 federal Medicare premium figures, see medicare.gov/basics/costs.

Worked example: single resident, Pennsylvania, 2026.

Eleanor is a single resident at a Pittsburgh nursing facility on Medicaid. Her income (Social Security plus a small pension) totals $3,200/month. Her deductions are the $60 PNA and her $202.90 standard Medicare Part B premium (she has no separate Part D premium, no MMNA because she is single, and no approved uncovered medical expenses). Her patient-pay is $3,200 minus $60 minus $202.90, which equals $2,937.10/month owed to the facility.3,1 Pennsylvania Medicaid pays the facility the difference between that figure and the facility's Medicaid per-diem rate, and Eleanor keeps the $60 PNA in a personal account.

Worked example: married resident, Pennsylvania, 2026.

Frank is in an Erie nursing facility on Medicaid; his wife Hilda lives at home and qualifies for an MMNA. Frank's combined Social Security and pension income totals $3,600/month. His deductions are the $60 PNA, his $202.90 Medicare Part B premium, and an MMNA deflection to Hilda under Pennsylvania's spousal-impoverishment framework. The federal maximum Monthly Maintenance Needs Allowance is $4,066.50/month, and the Minimum Monthly Maintenance Needs Allowance (MMMNA) base is $2,705.00/month for the July 1, 2026–June 30, 2027 cycle; the deflection fills the gap between Hilda's own income and her permitted allowance.4 Suppose the calculation permits Hilda a $700/month deflection. Frank's patient-pay is $3,600 minus $60 minus $202.90 minus $700, which equals $2,637.10/month.3,1 Hilda receives the $700 (added to her own income); Frank keeps the $60 PNA at the facility.

The PNA is preserved before patient-pay is calculated: it is the resident's first deduction, not a discretionary allocation from patient-pay. Even a resident whose income is just above the eligibility limit keeps the full $60.1

What the 2025 Increase Changed

Pennsylvania raised the nursing-facility PNA from $45 to $60 per month effective January 1, 2025, an increase of $15/month, or $180/year, and a 33% rise over the prior amount.1 For most residents the change was automatic: starting with January 2025 statements, the resident's PNA deposit at the facility was $60 instead of $45, and patient-pay obligations dropped by $15/month.1

In practical terms, the extra $15/month puts an additional haircut, a monthly newspaper subscription, or a small clothing item within reach.1 For residents with recurring medical-supply needs Medicaid does not cover, such as denture adhesive, hearing-aid batteries, and eyeglass repair, the additional amount helps cover replacements that previously competed with grooming and comfort purchases.

How Pennsylvania Compares to the Federal Floor

Federal law requires states to set the nursing-facility PNA at no less than $30/month for an institutionalized individual, a floor that has not changed since 1988. States may set the amount higher, as Tennessee does at $70.2 Pennsylvania's $60 is double the federal minimum and $10 below the $70 Tennessee protects.

Raising a PNA is not free to the state: because the PNA is the first deduction from a resident's income, every dollar of allowance is a dollar less of patient-pay, and Medicaid covers the gap between patient-pay and the facility's per-diem rate.1

For a state-by-state comparison, see Brevy's federal PNA hub.

Managing a PNA: Practical Guidance for Residents and Families

The recurring mistakes with a PNA are predictable, and most are avoidable with a few habits.

Know what the facility must provide, and don't pay for it. Facility-provided items (food, basic toiletries, basic personal care, basic linens, and basic replacement clothing as items wear out) should not come out of PNA. The most common error is paying PNA dollars for items the facility supplies for free. Ask the social-services director or business-office manager to clarify what is included.

Open a personal account. 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. Federal nursing-facility rules require an individualized account when the resident requests one; some residents leave funds in a general resident-funds account without asking for their own. In-house accounts are simpler for daily transactions; outside accounts give more banking flexibility but require more management.

Review the monthly statement. Facilities must provide a monthly statement showing the PNA deposit and any disbursements. Errors happen, most often a charge against PNA for something the facility should provide. Review each statement within 30 days and raise discrepancies with the business office immediately.

Track spending, and save toward larger purchases. A simple notebook or spreadsheet shows where the PNA goes each month and reveals patterns, such as too much in one category, or items the facility already provides. The PNA can also be saved across months: setting aside part of it for half a year can build a balance large enough for new shoes, a TV upgrade, or a holiday gift for grandchildren. Some residents accumulate balances without spending them, which usually signals they need help identifying items they would actually use.

Handle family gifts carefully. Family members can supplement the PNA with direct gifts of clothing, books, or comfort items, but should not deposit cash into the resident's PNA account in a way that counts as the resident's resources for Medicaid eligibility. A large cash deposit into the resident's account would count as the resident's resources and could push them over the resource limit. Direct gifts of goods are simpler and do not affect eligibility.

Plan for unspent PNA at death. Unspent PNA in the resident's facility account becomes part of the resident's probate estate at death, and Pennsylvania's probate-only estate recovery applies. Most residents leave very small balances, but families should be aware that a larger accumulated balance may be partially recovered.

Help the resident set priorities. Some residents struggle to say what they want to spend on. Family members can help by talking through past preferences (favorite foods, magazines they read, activities they enjoyed at home) and translating those into PNA purchases.

Where to Get Help

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.