If you or a parent is on Medicaid in a nursing home, almost all of your monthly income flows to the facility as patient liability. The single exception built into federal law is the Personal Needs Allowance (PNA), a small amount you keep each month for clothing, haircuts, toiletries, phone, and the small dignities that don't otherwise come out of the per-diem rate.

The PNA is one of the most misunderstood numbers in long-term care. The federal floor is $30/month, frozen since 1988. States can, and do, set higher figures: from $30 in Alabama to $200 in Alaska, with most states clustered in the $50–$80 band. In 2025–2026, a wave of states (Ohio, Pennsylvania, North Carolina, Illinois, Tennessee) finally raised their figures after years of advocacy, but the federal floor has not moved in 38 years.

This guide is the policy-translator's reference. It walks through the federal authority, the post-eligibility deduction math, the Resident Trust Fund mechanics nursing facilities are required to follow, how the VA pension cap interacts with state PNA, what happens to the PNA at death, and what the PNA Modernization Act (H.R. 5685, 119th Congress) would change. It includes the complete 2026 state-by-state PNA table and links to Brevy's state-level deep guides.

By Brevy Care Team

In This Guide

60-Second Version

The Personal Needs Allowance is the monthly residual income a Medicaid nursing-facility resident keeps for personal use after Medicaid takes the rest as patient liability.

  • Federal floor: $30/month for an individual; $60/month for an institutionalized couple. Frozen since 1988.
  • 2026 state range: $30 (Alabama) to $200 (Alaska).
  • Authority: 42 USC § 1396a(q); 42 CFR § 435.725 (institutional in 1634/SSI states); 42 CFR § 435.733 (209(b) states); 42 CFR § 435.726 (HCBS waivers); 42 CFR § 483.10(f)(10) (Resident Trust Fund).
  • What it covers: clothing, toiletries, haircuts, phone, magazines, snacks, modest gifts, religious offerings, hearing-aid batteries, replacement glasses, anything the per-diem doesn't cover.
  • What it doesn't cover: room, board, basic personal hygiene items the facility must provide, nursing services, food, activities, basic laundry. Charging the PNA for those is a federal violation (F-tag F571).
  • VA stacking: Veterans on Medicaid NF have their VA pension capped at $90/month under 38 USC § 5503(d), that $90 stacks WITH the state PNA. In Ohio: $75 + $90 = $165/month.
  • Recent state increases (2024-2026): OH ($50→$75 eff. 10/1/2025), PA ($45→$60 eff. 1/1/2025), NC ($30→$70 eff. 10/1/2023), IL ($30→$60 in 2023), TN raised to $70.
  • Pending federal bill: PNA Modernization Act (H.R. 5685, 119th Cong.), would double the federal floor to $60 individual / $120 couple. No committee markup as of May 2026.

What Is the Personal Needs Allowance?

When a Medicaid recipient enters a nursing facility (or an ICF/IID), federal law requires that almost all of their monthly income flow to the facility as patient liability, the resident's contribution to the per-diem rate before Medicaid pays the balance.

But Congress recognized that taking 100% would leave residents with no money at all for the small personal needs that aren't part of the room-and-board rate. So the post-eligibility income calculation reserves a personal needs allowance at the front of the deduction order.

Practically, the PNA is what shows up in the resident's "spend account" every month, the small balance they can use for:

  • Clothing, replacement shoes, seasonal sweaters, undergarments
  • Hair care, beauty shop appointments at the facility (most charge $15–$30 per visit; the per-diem rate covers only "basic hair care," not styling)
  • Toiletries beyond facility-provided basics, preferred deodorants, cosmetics, lotions, perfumes
  • Communication, cell phone bill, prepaid card, internet allowance
  • Reading and entertainment, magazine subscriptions, paperback books, streaming subscriptions
  • Snacks and outside food, vending machine, family-brought meals, restaurant outings
  • Modest gifts, birthday cards for grandchildren, holiday gifts
  • Religious offerings, donations during chapel services
  • Assistive technology, hearing-aid batteries (if not covered by Medicare), replacement reading glasses, repair to dentures or eyeglass frames
  • Pet care, therapy pet supplies (some facilities allow)

What it cannot lawfully be charged for, even if a facility tries: the per-diem rate is required to cover room, basic food, basic laundry, basic personal hygiene items, nursing services, dietary services, social services, activities, and routine therapy services. A facility that bills these against the resident's PNA violates 42 CFR § 483.10(g)(8) and is cited under F-tag F571 during state survey.

The PNA is small, a $50 allowance does not buy much in 2026, but it is the only personal money many institutionalized seniors have. Advocacy organizations frame it as a fundamental dignity floor, not a discretionary line item.

Federal Authority, Statute and Regulation

The statute: 42 USC § 1396a(q)

Section 1902(q) of the Social Security Act (codified at 42 USC § 1396a(q)) is the source of the federal PNA requirement. It directs every state Medicaid plan to:

Reduce the institutionalized individual's income (in the post-eligibility process) by a personal needs allowance for clothing and other personal needs of the individual while in the institution, not less than $30 per month for an aged, blind, or disabled individual, and not less than $60 per month for an institutionalized couple if both spouses are aged, blind, or disabled., 42 USC § 1396a(q)(2)

The companion provision at 42 USC § 1396a(a)(50) cross-references subsection (q) and makes provision of a PNA a mandatory state-plan requirement: a state Medicaid plan must "provide, in accordance with subsection (q) of this section, for a monthly personal needs allowance for certain institutionalized individuals and couples."

In the spousal-impoverishment context, 42 USC § 1396r-5(d)(1)(A) requires that the institutionalized spouse's post-eligibility calculation begin with "a personal needs allowance (described in section 1396a(q)(1) of this title), in an amount not less than the amount specified in section 1396a(q)(2)", i.e., the same $30 floor with state authority to set higher.

The regulations

The implementing regulations sit in Subchapter C of 42 CFR:

  • 42 CFR § 435.725, Post-eligibility treatment of income for institutionalized individuals in SSI/1634 states. This is the master rule for institutional PNA.
  • 42 CFR § 435.733, Parallel rule for institutionalized individuals in 209(b) states (currently CT, HI, IL, MN, MO, NH, ND, OK, VA, nine states that opted in 1972 to apply Medicaid eligibility rules at least as restrictive as their existing state plans).
  • 42 CFR § 435.726, Post-eligibility treatment for HCBS waiver enrollees in SSI states. The "maintenance needs of the individual" deduction here is what most practitioners call the SIMNA or Special Income Standard Maintenance Needs Allowance, a much higher figure than institutional PNA, set by states between 100% SSI FBR and 300% SSI FBR.
  • 42 CFR § 435.832, Parallel HCBS rule for 209(b) states.
  • 42 CFR § 483.10(f)(10), The Resident Trust Fund rule. Federal NF requirements of participation. Governs how facilities hold and account for resident personal funds.
  • 42 CFR § 483.10(g)(8), Limitations on charges to personal funds. Lists what facilities cannot charge against the PNA.

CMS interpretive guidance

  • CMS State Operations Manual Appendix PP, Surveyor guidance interpreting 42 CFR Part 483 (long-term care facility requirements). Issued and updated by CMS; current version contains F-tags F570 (Security of Personal Funds) and F571 (Limitations on Charges to Personal Funds) with detailed interpretive guidelines.
  • CMS State Medicaid Manual (SMM) §3700 series, Post-eligibility income treatment guidance. CMS has not raised the federal floor through SMM since OBRA-87 was enacted.
  • No State Medicaid Director (SMD) letter has directly addressed PNA floor amounts since 1988. CMS's only material guidance reaffirms state authority to set higher figures.

The $30 Federal Floor and Its 38-Year Freeze

The federal PNA floor of $30/month for individuals (and $60/month for institutionalized couples) is one of the longest-frozen dollar amounts in federal social policy.

Brief history

Year Floor Vehicle
1972 (authorized) / 1974 (enacted) $25/month Supplemental Security Act Amendments of 1972 (P.L. 92-603)
1988 (effective) $30/month Omnibus Budget Reconciliation Act of 1987, Pub. L. 100-203, § 4211, eff. July 1, 1988
1988 → present $30/month, unchanged No statutory increase in 38 years

What $30 in 1988 is worth in 2026

Using the U.S. Bureau of Labor Statistics CPI-U:

  • 1988 CPI: 115.4
  • 2026 CPI (March 2026): ~324
  • Inflation factor: 324 ÷ 115.4 = 2.81×
  • $30 in 1988 is equivalent to ~$84 in 2026 dollars.

Put another way: the real purchasing power of $30 has eroded by approximately 64% since 1988. To maintain the dignity floor Congress set in OBRA-87, the federal floor in 2026 would need to be approximately $84/month for individuals and $168/month for couples.

The advocacy estimates from Justice in Aging, the National Consumer Voice for Quality Long-Term Care, AARP Public Policy Institute, and the Dignity Alliance Massachusetts converge on this ~$80–$90 in-2026-dollars equivalent.

Why the floor hasn't moved

The reasons are political, not technical:

  1. No automatic indexing. Unlike SSI federal benefit rate (annual COLA), the SSI resource limit (since 1989), or the home-equity exclusion (annual CMS update), the PNA floor has no statutory indexing trigger.
  2. No must-pass vehicle. Each iteration of the PNA Modernization Act (H.R. 3853 of the 116th Congress, H.R. 7682 of the 118th, H.R. 5685 of the 119th) has been introduced as a stand-alone bill and died in committee. There has been no opportunity to attach the increase to OBRA-style reconciliation legislation since 1987.
  3. State autonomy framing. Some Medicaid administrators and state-budget officials privately argue that the federal floor is a baseline only, states are free to set higher, and that a federal increase is "unnecessary." Advocates counter that the unindexed floor leaves residents in low-PNA states (Alabama at $30, California at $35, Arkansas at $40) without basic dignity.
  4. Cost-shift visibility. Because raising PNA reduces patient liability and increases state Medicaid NF outlays (the resident contributes less toward per-diem; the state share rises proportionally), each $1 of PNA increase across 50,000 NF Medicaid residents = ~$600,000/year of additional state Medicaid outlay. State legislatures see the cost-shift; they don't always see the unmet personal needs of residents.

The 2025 wave of state-level increases (Ohio, Pennsylvania, North Carolina, Illinois, Tennessee, Connecticut, Minnesota) reflects bottom-up advocacy moving where federal action has not.

The Post-Eligibility Deduction Order (with Worked Example)

Federal regulation 42 CFR § 435.725(c) (institutional, SSI/1634 states) and 42 CFR § 435.733(c) (institutional, 209(b) states) prescribe a deduction order that applies before a resident's "patient liability" (sometimes called "share of cost," "applied income," or "Net Available Monthly Income" depending on the state) is computed.

The order:

  1. Personal Needs Allowance, at least $30/month individual; states set higher. Some states add an earned-income deduction (e.g., Ohio's additional $65/month for working residents).
  2. Maintenance needs of the community spouse, the Community Spouse Monthly Income Allowance (CSMIA). The institutionalized spouse may shift income to the community spouse up to the Minimum Monthly Maintenance Needs Allowance (MMMNA) of $2,643.75/month (federal floor through 6/30/2026) up to the MMMNA ceiling of $4,066.50/month (1/1/2026 figures). The MMMNA may be expanded above the cap by court-ordered support or fair hearing.
  3. Maintenance needs of dependents, dependent children, disabled adult children, or dependent parents living with the community spouse.
  4. Health insurance premiums and incurred medical/remedial care expenses, - Medicare Part B premium (standard $202.90/month for 2026, IRMAA brackets above)
    • Medicare Part D premium (national average ~$36.78/month for 2026; many NF residents pay $0 via the Low-Income Subsidy)
    • Medigap or Medicare Supplement premium (typically dropped upon Medicaid eligibility)
    • Dental, vision, hearing premiums if separately maintained
    • Necessary medical/remedial care not covered by Medicaid and recognized under state law
  5. (Optional) A 6-month home-maintenance allowance with physician certification of likely return, covers mortgage, utilities, insurance, basic upkeep on a primary residence the resident may return to.
  6. (SSI states only) Continued SSI/SSP benefit pass-through under SSA § 1611(e)(1)(E) and (G) for the first months of institutionalization (the so-called "$30+SSP" rule for SSI recipients newly institutionalized).

= Patient Liability (paid directly by the resident or the QIT/Miller Trust to the facility each month).

Worked example, Florida resident, 2026

Facts: 79-year-old widow in Medicaid NF in Florida. Income: Social Security $1,800/month + small pension $300/month = $2,100/month gross. Has Medicare Part B (auto-deducted at $202.90/month from her SS check). She kept her Medigap Plan G ($165/month). She has Part D premium ($45/month, she's in a Standard Plan, not LIS-eligible because she has the small pension). No community spouse. No dependents. PNA: Florida $160.

Step Item Amount
Gross income SS $1,800 + Pension $300 $2,100.00
Deduction 1 Personal Needs Allowance (Florida $160) – $160.00
Deduction 2 (no community spouse) $0
Deduction 3 (no dependents) $0
Deduction 4a Medicare Part B premium (2026 standard) – $202.90
Deduction 4b Medigap Plan G premium – $165.00
Deduction 4c Part D premium – $45.00
= Patient Liability paid to NF $1,527.10

The Florida NF receives Medicaid's NF per-diem minus $1,527.10 from the resident each month. The resident's Resident Trust Fund account receives the $160 PNA, and her premiums are paid as listed. Her bank account at month-end shows $160.

Same example, Alabama instead

Step Item Amount
Gross income SS $1,800 + Pension $300 $2,100.00
Deduction 1 Personal Needs Allowance (Alabama $30, federal floor) – $30.00
Deduction 2 (no community spouse) $0
Deduction 3 (no dependents) $0
Deduction 4a Medicare Part B premium – $202.90
Deduction 4b Medigap Plan G premium – $165.00
Deduction 4c Part D premium – $45.00
= Patient Liability paid to NF $1,657.10

The Alabama resident has the same income, same per-diem, same Medicare cost structure as the Florida resident, but $130 less per month in personal funds. Over a 5-year stay, that gap is $7,800 in lost personal funds for an Alabama resident vs. a Florida resident. This is the practical impact of state PNA variation.

Resident Trust Fund, Federal Mechanics

When a Medicaid NF resident requests that the facility hold their personal funds (as most do, because they have no community spouse to manage banking), federal law sets out detailed protections at 42 CFR § 483.10(f)(10).

The core requirements

  1. No required deposit. The facility cannot require a resident to deposit personal funds with the facility. The deposit is at resident (or representative) request only, in writing.
  2. Separate accounting. Resident funds may not be commingled with facility operating funds or with another resident's personal property. Generally accepted accounting principles apply. Pooled-account structures (with separate accounting per resident) are permitted.
  3. Interest-bearing for balances over $50. For Medicaid residents, any balance over $50 must be deposited in a separate interest-bearing account at a prevailing rate, with all interest credited to the resident. (For non-Medicaid residents, the threshold is $100.)
  4. Petty cash for balances under $50. Balances of $50 or less may be in a non-interest-bearing or petty-cash account.
  5. Quarterly statements. The facility must provide a quarterly statement to the resident or representative, with on-demand access to records.
  6. Resource-limit notice. The facility must notify the resident in writing when the trust balance approaches the Medicaid resource limit ($2,000 for ABD recipients in most states), so the resident can spend down before losing eligibility.
  7. Surety bond. The facility must purchase a surety bond or equivalent assurance to the Secretary of HHS protecting all resident deposits. FDIC bank-deposit insurance alone is insufficient.
  8. 30-day window upon discharge or death. Within 30 days of the resident's discharge or death, the facility must convey funds and a final accounting to the resident, the resident's representative, or, at death, the estate administrator.

State-level operational rules

Most states layer a more detailed operational rule on top of the federal floor. Examples:

  • Ohio (OAC 5160-3-16.5): Surety bond must equal full deposit balance + accrued interest + refundable deposits; balances over $50 must move to interest-bearing account within 5 banking days; quarterly statement within 30 days of quarter-end; at death, 60-day estate window before transfer to ODM.
  • Texas (26 TAC § 554.302): Parallel structure; HHSC guidance.
  • New York (10 NYCRR § 415.4): Includes detailed form-of-statement requirements.
  • California (22 CCR § 72527): Includes additional resident-grievance protections.

F-tag enforcement

The federal Resident Trust Fund rule is enforced through state survey under CMS contract:

  • F570, Security of Personal Funds. Cited when a facility fails to maintain separate accounting, doesn't post quarterly statements, doesn't carry the surety bond, or doesn't follow the interest-bearing-account rule.
  • F571, Limitations on Charges to Personal Funds. Cited when a facility charges the PNA for items the per-diem rate is required to cover (basic personal hygiene items, room maintenance, basic laundry, nursing services, food, activities, etc.).

A facility cited at the immediate jeopardy level on F570 or F571 faces civil monetary penalties and possible enforcement remedies up to and including denial of payment for new admissions or termination from the Medicare/Medicaid program.

Charges the facility cannot make against the PNA

Per 42 CFR § 483.10(g)(8), the facility cannot charge resident funds for any item or service for which the per-diem rate or Medicaid/Medicare reimbursement already pays. The non-charge list includes:

  • Nursing services (including LPN/RN time, restorative nursing)
  • Food and nutrition services (basic meals, dietary consults)
  • Routine personal hygiene items provided by the facility (soap, shampoo of facility brand, lotion, deodorant, basic toothbrush, comb, oral hygiene products, hair/nail hygiene, bath, shave items)
  • Routine bed/room maintenance, cleaning, basic laundry
  • Medically related social services
  • Activities programming
  • Basic therapy services included in the per-diem (PT, OT, ST routine sessions, when not Medicare Part A skilled or Part B billed)
  • Hospice room and board (when resident has elected the hospice benefit)

The facility CAN charge resident funds, with explicit prior consent, for:

  • Personal preference items beyond the facility-provided basics (specific brand of toothpaste, cosmetics)
  • Beauty/barber shop services (typically $15–$30 per visit; common PNA expenditure)
  • Telephone (private line, long-distance, cell phone)
  • Television (private set, cable upgrade beyond facility-provided)
  • Personal clothing
  • Outside-of-facility entertainment
  • Tobacco products (where facility allows)
  • Newspapers, magazines
  • Notions and gifts
  • Flowers, plants

PNA Across Settings

Institutional PNA, Nursing Facility (NF) / Skilled Nursing Facility (SNF)

The standard PNA applies under 42 CFR § 435.725(c)(1)(i) in SSI/1634 states or § 435.733 in 209(b) states. Federal floor: $30/month individual, $60/month institutionalized couple. State range: $30 (AL) to $200 (AK).

ICF/IID, Intermediate Care Facility for Individuals with Intellectual Disabilities

The same federal floor applies under the same regulatory provisions. State implementation varies, most states set ICF/IID PNA equal to NF PNA, but oversight typically falls to the state Department of Developmental Disabilities (e.g., Ohio's DODD under OAC 5123-7-09, Texas HHSC). Some states (Illinois at $120 for SLP, Supportive Living Program, residents) carve out higher figures for DD residents reflecting longer length of stay and different community-integration needs.

Assisted Living Waiver maintenance allowance (ALMNA)

When a state offers an Assisted Living Waiver under § 1915(c), the resident is technically a community-based HCBS waiver recipient, not institutionalized for federal-rule purposes. The "PNA" in this setting is more accurately called the Assisted Living Maintenance Needs Allowance (ALMNA) and is structured very differently:

  • Standard math: SSI federal benefit rate ($994/month for 2026) − Room & Board (state-set, capped to facility's actual cost) = ALMNA.
  • The resident keeps the ALMNA for actual community living expenses, telephone, clothing, medications, ancillary services, transportation, personal items.

Examples:

  • Ohio ALW (OAC 5160:1-6-08): $994 SSI FBR − $944 R&B cap = $50 ALMNA. (Notably NOT raised in 2025 alongside Ohio's NF PNA increase, a gap that the Ohio Aging Advocacy Coalition and LeadingAge Ohio publicly flagged.)
  • Florida ALW (Statewide Medicaid Managed Care - Long-Term Care): Resident retains ~$160 (parallels NF PNA).
  • Texas STAR+PLUS Waiver ALW: Resident retains the same $75 NF PNA structure.

Federal authority is § 1915(c) and 42 CFR § 435.726(c)(1), there is no specific federal floor for ALW distinct from institutional PNA, leaving states meaningful design flexibility.

HCBS waiver maintenance allowance, SIMNA / Community PNA

For 1915(c) waiver enrollees living in their own homes (PASSPORT in Ohio, MLTC in New York, STAR+PLUS in Texas, Choices in Tennessee), the post-eligibility calculation under 42 CFR § 435.726 uses a much higher "maintenance needs of the individual" figure to reflect actual community living expenses. This figure goes by various names:

  • SIMNA, Special Income Standard Maintenance Needs Allowance (Ohio's term)
  • Community PNA, Tennessee's term for HCBS Group 2/3 residents
  • HCBS Maintenance Allowance, generic term

States peg this allowance from 100% of SSI FBR to 300% SSI FBR (= the Medicaid Special Income Limit, $2,982/month for 2026):

  • 100% SSI FBR ($994/month for 2026): Most restrictive, used by parts of California's In-Home Operations.
  • 138% FPL (~$1,800/month): New York MLTC.
  • 65% of Special Income Limit ($1,938.30/month): Ohio's PASSPORT, Ohio Home Care, MyCare HCBS waivers (eff. 6/1/2025 under OAC 5160:1-6-07.1).
  • 300% SSI FBR ($2,982/month): Tennessee Choices Group 2/3, full Special Income Limit retention.

The HCBS maintenance allowance is mathematically distinct from institutional PNA and frequently produces much lower or zero patient liability for HCBS recipients vs. their NF counterparts, even though the same federal Medicaid program funds both.

PACE (Program of All-Inclusive Care for the Elderly)

For PACE participants who live in the community, the HCBS-style maintenance allowance applies. PACE participants who transfer to a NF (rare; typically <5% of PACE census) flip to institutional PNA. Authority: 42 USC § 1396u-4(b)(2)(C); CMS PACE manual.

Hospice in NF

Hospice election does not change the resident's PNA. A NF Medicaid resident who elects the Medicare hospice benefit retains the same NF PNA as before. The room-and-board portion continues to be paid by Medicaid to the NF; the hospice agency receives separate per-diem from Medicare (or Medicaid hospice if Medicare-ineligible). The resident's PNA continues to be governed by 42 CFR § 483.10(f)(10) and the state's institutional rule.

Complete 2026 State-by-State PNA Table

The figures below reflect the institutional NF PNA in effect on January 1, 2026, sourced primarily from the National Consumer Voice 2025 chart (eff. FY2025) and GotLTCi's January 2026 update, with state Medicaid agency rule pages used as the tiebreaker. Where states have separate ALW or HCBS allowances, see the PNA across settings section above and the linked state deep guides.

Highest PNA tier

State 2026 PNA Notes
Alaska $200.00 Highest in nation
Nevada $163.00
Florida $160.00 Substantially indexed historically
Arizona $149.10 Indexed (10% SSI FBR + Arizona supplement)
Minnesota $132.00 209(b) state
North Dakota $115.00 209(b) state
Colorado $110.36
DC $109.00
Washington ~$108.74 Mid-year recalculation; verify current figure with WA HCA
Maryland $106.00
South Dakota $100.00

Mid-tier, $70–$99

State 2026 PNA Notes
New Mexico $97.00
New Hampshire $93.00 209(b) state
Oregon $81.28
Vermont $79.93
Connecticut $75.00 $165/mo for wartime veterans (statutory differential under Conn. Gen. Stat. § 17b-272); raised $60→$75 eff. 7/1/2021
Delaware $75.00
Hawaii $75.00 209(b) state
Nebraska $75.00
Ohio $75.00 Raised $50→$75 eff. 10/1/2025; ALW remains $50
Oklahoma $75.00 209(b) state
Rhode Island $75.00
Texas $75.00
Massachusetts $72.80 Statutorily fixed since FY2008; pending S.887/H.1411 would raise to $100 + add CPI-U indexing eff. 7/1/2027
Georgia $70.00 Recent increase 2023-2024
North Carolina $70.00 Raised $30→$70 eff. 10/1/2023 (S.L. 2023-134)
Tennessee $70.00 Group 1 NF residents; HCBS Group 2/3 = $2,982 Community PNA

Mid-low tier, $50–$69

State 2026 PNA Notes
Kansas $62.00
Illinois $60.00 Raised $30→$60 in 2023 (HB 4343 of 102nd GA); SLP residents up to $120; 209(b) state
Kentucky $60.00
Michigan $60.00
Pennsylvania $60.00 Raised $45→$60 eff. 1/1/2025 (LTC Handbook Ch. 468.3)
South Carolina $60.00
Iowa $55.00
Wisconsin $55.00
Indiana $52.00
Missouri $50.00 209(b) state
Montana $50.00
New Jersey $50.00
New York $50.00
West Virginia $50.00
Wyoming $50.00

Lowest tier, $30–$49

State 2026 PNA Notes
Mississippi $44.00 $90/month for VA pension recipients (state-specific structure, verify with MS DOM rule)
Utah $45.00
Louisiana $45.00
Idaho $40.00
Maine $40.00
Arkansas $40.00
Virginia $40.00 209(b) state
California $35.00 $35 NF; $62 for SSI categorical Medi-Cal NF
Alabama $30.00 Federal floor; only "true floor" state in 2026

Recent state increases (2024-2026)

The 2025 wave shifted the national distribution:

  • Ohio: $50 → $75 eff. 10/1/2025 (administrative rulemaking under OAC 5160:1-6-07 after Gov. DeWine line-item-vetoed HB 96 budget language and directed ODM to implement)
  • Pennsylvania: $45 → $60 eff. 1/1/2025 (first PA increase since 2007)
  • Tennessee: raised to $70 (recent, see TN deep guide)
  • North Carolina: $30 → $70 eff. 10/1/2023 (Session Law 2023-134; very large jump from federal floor)
  • Illinois: $30 → $60 in 2023 (House Bill 4343)
  • Connecticut: $60 → $75 eff. 7/1/2021
  • Minnesota: raised to $132 (recent)
  • Georgia: raised from $30s to $70 (2023-2024)

Sources for the table

  • National Consumer Voice for Quality Long-Term Care, "PNA by State 2025 Chart," August 2025.
  • GotLTCi, "What Your State Lets You Keep, 2026 PNA Chart," January 2026 update.
  • State Medicaid agency rule pages (linked in the Brevy state pillars section below).

How States Comply and Vary, Four Typologies

"Floor" states, exactly $30

Only Alabama sits at the federal floor of $30 in 2026. (Pre-2023, the floor cohort included Alabama, North Carolina, Illinois, and Georgia; NC, IL, and GA have all since raised.)

"Indexed" states, peg to SSI FBR or formula

A minority of states formally index PNA to a federal benchmark:

  • Arizona ($149.10 at 10% SSI FBR + state supplement)
  • Maryland ($106, partially indexed)
  • Vermont ($79.93, partially indexed)

Most states use fixed dollar amounts that require legislative or administrative action to change. This is the principal reason real-value erosion has been so severe, fixed-amount states require periodic re-legislation, and the political momentum for an increase only builds every several years.

"Tiered" states, different by setting

  • Ohio: $75 NF / $50 ALW / SIMNA $1,938.30 HCBS / ICF/IID $75 (likely)
  • Tennessee: $70 NF (Group 1) / $2,982 Community PNA (HCBS Group 2/3)
  • California: $35 standard NF / $62 SSI categorical NF / In-Home Operations community
  • Illinois: $60 NF / $120 SLP (Supportive Living Program)
  • Connecticut: $75 standard NF / $165 wartime veterans
  • Mississippi: $44 standard / $90 VA pension recipients
  • Florida: $160 NF / ~$160 ALW / SIMNA HCBS

"Earned-income" states, additional disregards for working residents

A handful of states let residents who continue to work (sheltered work programs, ICF/IID community employment, NF on-site work) keep additional earned income beyond the standard PNA:

  • Ohio (OAC 5160:1-6-07(I)(3)): $65/month earned-income deduction above $75 PNA.
  • Texas (26 TAC § 358.435): Limited earned-income disregard for working NF residents.
  • California (22 CCR § 50603 et seq.): Variant for working SSI categorical recipients.

Most states do not offer earned-income disregards beyond the standard PNA.

209(b) states (currently 9 active in 2026)

The 209(b) states elected in 1972 to apply Medicaid eligibility rules at least as restrictive as their pre-1972 state plans. Their PNAs follow 42 CFR § 435.733 (mirrors § 435.725 substantively). The 209(b) cohort in 2026:

  • Connecticut ($75)
  • Hawaii ($75)
  • Illinois ($60)
  • Minnesota ($132)
  • Missouri ($50)
  • New Hampshire ($93)
  • North Dakota ($115)
  • Oklahoma ($75)
  • Virginia ($40)

(Some legal-aid and elder-law sources still characterize New York as 209(b); CMS treats NY as a 1634-state with 209(b)-like medically-needy and resource-test variations.)

VA Pension and the $90 Cap, How Stacking Works

A common question for veteran families: when a wartime veteran enters a Medicaid nursing facility, what happens to their VA pension? The answer is governed by 38 USC § 5503(d) and its implementing regulation 38 CFR § 3.551(i).

The $90 cap

For a single veteran (no spouse, no child) on Medicaid NF coverage, VA pension is capped at $90/month beginning the month after admission. This includes all three flavors of VA pension:

  • Improved Pension (the standard low-income wartime-veteran benefit)
  • Aid & Attendance (A&A) (additional benefit for veterans needing help with ADLs)
  • Housebound (benefit for housebound veterans)

The cap also applies to surviving spouses without children under 38 USC § 5503(d)(5) and to children receiving § 1542 pension.

There is no carve-out for 100%-rated veterans, nor for those in highest-tier A&A. The only complete exemption from § 5503(d) reduction is for Hansen's-disease care under § 5503(b).

The provision currently sunsets January 31, 2033 (extended from prior expirations by recent VA appropriations / pension acts).

How $90 stacks with state PNA, the federal pre-emption

Critically, the $90 VA pension is NOT counted as countable income for the Medicaid post-eligibility calculation. Federal law treats VA payments as exempt for Medicaid purposes (with narrow exceptions). The $90 flows directly to the veteran for personal use, IN ADDITION to the state PNA.

Stacking math by state:

  • Ohio: $75 PNA + $90 VA = $165/month total personal funds
  • Florida: $160 PNA + $90 VA = $250/month
  • Massachusetts: $72.80 PNA + $90 VA = $162.80/month
  • Tennessee: $70 PNA + $90 VA = $160/month
  • Alabama: $30 PNA + $90 VA = $120/month

The $90 VA pension is deposited to the veteran's Resident Trust Fund account and is governed by the same 42 CFR § 483.10(f)(10) protections as the state PNA.

Veterans with a spouse or dependent child

If the veteran is married or has a dependent child, the $90 cap does not apply. The full pension continues, typically with adjustments for unreimbursed medical expenses (UMEs) under VA rules. The community spouse retains community-spouse Medicaid protections (CSMIA, MMMNA up to $4,066.50/month for 2026).

This is a meaningful difference: a single Korea-era veteran in an Ohio NF retains $165/month total personal funds; a married Vietnam-era veteran in the same NF retains his full pension (potentially $1,500+/month for A&A) plus the $75 PNA, with the spouse's MMMNA also protected.

State-level interactions

A few states adjust their PNA structure for VA pension recipients:

  • Mississippi: PNA structure differs for VA pension recipients (some sources show $90 PNA in lieu of $44 standard; others suggest $44 + $90 stack). Recommendation: confirm with MS DOM rule before relying on this number.
  • Connecticut: Wartime veterans receive a $165/month PNA (vs. $75 standard) under Conn. Gen. Stat. § 17b-272, a state-level differential reflecting Connecticut's policy choice to absorb the federal $90 cap into its state PNA.

Medicare Part B and Part D Premium Interaction

2026 Medicare Part B

CMS announced in November 2025 that the standard 2026 Medicare Part B premium would be $202.90/month (up from $185 in 2025, a 9.7% YoY increase) with a deductible of $283/year. IRMAA brackets above the standard rate apply for higher-income beneficiaries (≥$109,000 single MAGI / ≥$218,000 MFJ).

The Part B premium is deduction #4 in the post-eligibility calculation under 42 CFR § 435.725(c). It comes out of countable income before patient liability is computed, it does NOT come out of the PNA.

Dual-eligibles and the QMB pathway

For dual-eligible Medicare-Medicaid beneficiaries enrolled in a Medicare Savings Program:

  • QMB (Qualified Medicare Beneficiary, ≤100% FPL): The state pays the Part B premium directly. There is no Part B deduction in the post-eligibility calculation. The PNA still applies in full.
  • SLMB (Specified Low-Income Medicare Beneficiary, ≤120% FPL): The state pays the Part B premium. No deduction; PNA in full.
  • QI (Qualifying Individual, ≤135% FPL): The state pays the Part B premium. No deduction; PNA in full.
  • Full-Benefit Dual-Eligible (FBDE): Almost always also QMB, the state pays Part B. PNA in full.

In practice, the vast majority of NF Medicaid residents are FBDE/QMB, meaning the state pays the Medicare Part B premium and Step 4 of the deduction order is $0 for them.

Part D and the Low-Income Subsidy

Medicare Part D premiums vary by plan; the 2026 national average for a Standard Plan is approximately $36.78/month. However, NF residents are typically auto-enrolled in the Low-Income Subsidy (LIS), which provides $0-premium Standard Plans. Most NF residents pay $0 in Part D premiums.

The LIS is a separate Medicare Part D subsidy administered by CMS, distinct from the Medicare Savings Programs that pay Part B. Eligibility for LIS automatically applies to anyone receiving Medicaid (full-benefit or QMB), regardless of state.

Medigap and supplemental insurance

Most LTC NF residents drop their Medigap (Medicare Supplement Insurance) policies upon Medicaid eligibility. Medicaid as secondary payer covers most cost-sharing the Medigap would have absorbed. In the rare case where a resident retains Medigap, the premium is deductible in Step 4 of the post-eligibility calculation.

PNA at Death, The 30-Day Window and Estate Recovery

When a Medicaid NF resident dies, the federal Resident Trust Fund rule at 42 CFR § 483.10(f)(10) requires the facility to convey the resident's remaining funds and provide a final accounting within 30 days to:

  • The resident's legally appointed representative (executor, administrator, or, pre-probate, surviving POA with estate authority)
  • The resident's surviving spouse if they are the legal heir
  • The resident's estate, once probate is opened

State-level operational rules often set a longer outside window (e.g., Ohio's OAC 5160-3-16.5 sets a 60-day estate window before transfer to ODM if no estate has been opened).

Practical reality of small balances

Most PNA balances at death are small, typically $0 to $2,000, kept below the Medicaid resource limit ($2,000 for ABD recipients) during life. Common dispositions:

  • Used for funeral or burial: Many residents pre-establish irrevocable burial reserves (federally exempt under 42 CFR § 435.701); remaining PNA at death is often consumed by funeral expenses.
  • Small-estate affidavit transfer: PNA balances frequently fall within state small-estate thresholds and pass to next of kin via affidavit, avoiding probate entirely:
    • Texas (Estates Code § 205.001): ≤ $75,000
    • California (Probate Code § 13100): ≤ $184,500 (2026, indexed)
    • New York (SCPA § 1301): ≤ $50,000
    • Florida (F.S. § 735.301): ≤ $75,000 + 2 years post-death (summary administration)
    • Pennsylvania (20 Pa. C.S. § 3102): ≤ $50,000 (excluding family exemption)
    • Ohio (ORC § 2113.03): ≤ $35,000 (release from administration); ORC § 2113.031: ≤ $5,000 OR amount of funeral (summary release)

Estate recovery treatment

Under 42 USC § 1396p(b)(1), states must recover Medicaid expenditures from the probate estates of deceased Medicaid recipients aged 55+ at the time of NF or HCBS service receipt. Approximately 25 states extend recovery to non-probate transfers ("expanded recovery"), Ohio, Iowa, Massachusetts, North Carolina, and others. The remaining ~25 are probate-only (including Tennessee under SPA TN-24-0002 effective 4/1/2024, with a $10,000 minimum recovery threshold per TCA § 71-5-116).

PNA balances ARE recoverable as part of the deceased resident's estate, subject to:

  • Federal mandatory exemptions: surviving spouse (deferred), minor child, blind/disabled child of any age
  • State hardship waivers under 42 CFR § 433.36(h): most states have application processes (e.g., 55 Pa. Code § 258.10 in PA; OAC 5160:1-2-07 in OH; 22 CCR § 50961 in CA)
  • State de minimis thresholds: Pennsylvania waives recovery on estates under $2,400; Florida under $3,000; some states have higher thresholds
  • State-specific carve-outs: caregiver child residing in home; sibling continuity exception (with prior equity interest); long-term occupant exception

Practical recovery posture

In practice, states with aggressive expanded recovery (Ohio's expanded recovery under ORC § 5162.21; Iowa's similar structure) may pursue PNA balances as part of the estate even when small. States with probate-only recovery typically do not pursue de minimis amounts where the cost of pursuit exceeds the recovery (PA's $2,400 threshold reflects this practical calculation).

The full federal and state framework is covered in Brevy's Medicaid Estate Recovery federal guide.

The PNA Modernization Act (H.R. 5685)

Current bill (119th Congress)

H.R. 5685, the PNA Modernization Act, was introduced in the 119th Congress by Rep. Jan Schakowsky (D-IL-9). It would amend 42 USC § 1396a(q)(2) to:

  • Raise the federal floor for an aged, blind, or disabled individual from $30 → $60/month
  • Raise the federal floor for an institutionalized couple from $60 → $120/month

The bill was referred to the House Energy & Commerce Committee and, as of May 2026, has not received a markup, hearing, or floor action. This trajectory parallels prior iterations.

Earlier iterations

  • H.R. 3853 (116th Congress, 2019-2020), Schakowsky, would have raised the floor to $50/month. Died in committee.
  • H.R. 7682 (118th Congress, 2023-2024), Schakowsky, would have raised the floor to $60 individual / $120 couple. Died in committee.
  • H.R. 5685 (119th Congress, 2025-2026), current. Same headline figures as 7682.

A companion or parallel bill H.R. 7778 (119th Congress) has also been introduced under the broader "Medicaid PNA Modernization" framework. As of May 2026, it has not advanced.

Endorsements

  • Justice in Aging (lead policy advocate)
  • National Consumer Voice for Quality Long-Term Care
  • AARP and AARP Public Policy Institute
  • Dignity Alliance Massachusetts (state-level model coalition)
  • Center for Medicare Advocacy
  • LeadingAge (national + state chapters)

State-level "modernization" pressure

The 2025 wave of state-level PNA increases, Ohio, Pennsylvania, North Carolina, Illinois, Tennessee, Connecticut, Minnesota, Georgia, reflects the same advocacy pressure operating at the state level given persistent federal inaction. Many state increases tracked the introduction or re-introduction of the federal bill; advocates use the federal bill's introduction as political leverage in state legislatures.

If H.R. 5685 (or successor) eventually passes, the new federal floor would only raise the floor, states already at $60+ would be unaffected. Practically, it would matter most for AL ($30 → $60 floor), CA ($35 → $60), and AR/ID/ME/UT/VA ($40-$45 → $60).

Why the PNA Matters, Advocacy Positions

The core dignity argument

The PNA is the only personal money many institutionalized seniors have. Without it, residents cannot:

  • Replace worn-out clothing or shoes
  • Purchase preferred toiletries beyond facility-provided basics
  • Pay for haircuts and beauty/barber services (typically $15–$30 per session)
  • Maintain a phone (cell, landline, or even prepaid card)
  • Buy hearing-aid batteries (Medicare Part B does not cover hearing aids; many residents self-pay)
  • Replace eyeglasses or repair frames
  • Subscribe to magazines or stream entertainment
  • Send modest birthday or holiday gifts to grandchildren
  • Make small religious offerings during chapel services
  • Have spending money for outside-of-facility excursions when family takes them out

The $30 problem

In Alabama in 2026, the institutional Medicaid resident receives $30/month, federally adjusted, that's worth about $11 in 1988 dollars. A haircut costs more than the entire monthly PNA. A sweater or pair of shoes costs more. A month of basic cell phone service costs more.

Multiple longitudinal studies from Consumer Voice, AARP, and Dignity Alliance Massachusetts document the practical consequences: residents skip clothing replacement, go without hair care, forego assistive technology repairs, and rely on family donations for personal items the per-diem rate is supposed to provide.

The state-by-state inequality

A federally identical Medicaid program produces a 6.7× differential in personal allowances based purely on geography, $30 in Alabama vs. $200 in Alaska, for residents with otherwise identical incomes, identical facility costs, and identical Medicare premiums. Two Medicaid recipients in NFs across state lines from each other can have radically different monthly personal funds.

Counter-arguments

State Medicaid administrators raise three main concerns:

  1. Cost shift: Each $1 PNA increase across all NF Medicaid residents in a state with 50,000 NF Medicaid census = ~$600,000/year cost-shift from resident to state share-of-cost.
  2. State autonomy: The federal floor is a baseline; states are free to raise. Some argue federal increase is unnecessary.
  3. Operational complexity: State Medicaid systems must reprogram for any federal floor change; states already at $50–$80 see little practical benefit.

These arguments have not prevailed at the state level in the 2024-2026 wave. Whether they prevail at the federal level remains to be seen.

Brevy State Pillars

Brevy maintains state-level deep guides for the major dual-eligible and high-NF-census states. Each links the state's specific 2026 PNA mechanics, ALW maintenance allowance, HCBS structure, post-eligibility calculation, and Resident Trust Fund implementation.

Common Misconceptions and Pitfalls

1. "The PNA covers basic personal hygiene items." It doesn't have to, the per-diem does. Federal regulation 42 CFR § 483.10(g)(8) requires the facility to provide basic personal hygiene items as part of the per-diem rate (basic soap, shampoo, lotion, deodorant, toothbrush, toothpaste, comb, oral hygiene products, basic shave and bath items). Charging the PNA for these is a cited violation. If a facility is doing this, ask the LTC Ombudsman to address it.

2. "The federal floor is $30 per resident." It's $30 per month, regardless of resident. The floor is a monthly amount, not a per-event cap or per-good ceiling.

3. "A higher state PNA reduces what the resident pays." Sort of, but mainly it shifts cost to the state. The PNA reduces patient liability dollar-for-dollar. A $25 PNA increase = $25/month less to the facility from the resident, $25/month more from state Medicaid. The facility's per-diem total is unchanged.

4. "Veterans get full pension on Medicaid NF." Single veterans don't. 38 USC § 5503(d) caps single-veteran VA pension at $90/month after Medicaid NF placement. That $90 stacks with state PNA, but the overall pension is dramatically reduced. Married veterans are a different story.

5. "Medicare Part B comes out of the PNA." No, Part B is a separate deduction in Step 4. Part B is deducted from countable income BEFORE patient liability is computed. The PNA is preserved.

6. "Hospice election ends the PNA." It doesn't. A NF Medicaid resident who elects the Medicare hospice benefit retains the same NF PNA as before. The hospice agency receives separate per-diem; the resident's PNA continues unchanged.

7. "The facility can require a deposit to manage funds." It can't. 42 CFR § 483.10(f)(10) prohibits required deposits. The deposit is at resident or representative request only, in writing.

8. "PNA balances over $2,000 cause Medicaid ineligibility." Yes, but the facility must warn first. The facility is required to notify the resident in writing when the trust balance approaches the Medicaid resource limit ($2,000 for ABD recipients). Spend-down options include: irrevocable burial reserve, replacement clothing, dental work, hearing aids, eyeglasses, assistive technology, prepaid funeral.

9. "PNA at death goes to the facility." It doesn't. The 30-day federal window (longer in some states) requires conveyance to the resident's representative or estate. State estate recovery may then claim a portion.

10. "The PNA is taxable income." No, it's not new income; it's the residual of the resident's own income after deductions. Social Security, pension, and other income flowing to the resident remain taxable as before; the PNA is not additional taxable receipt.

11. "$30 has been adjusted for inflation." It hasn't been since 1988. The federal floor has been frozen for 38 years. The pending PNA Modernization Act would double it to $60.

12. "ALW residents get the same PNA as NF residents." Often not. Many states set the Assisted Living Waiver maintenance allowance separately from NF PNA, and the math is structurally different (typically SSI FBR minus state Room & Board). Ohio's 2025 NF increase to $75 did not extend to ALW, which remains at $50.

Where to Get Help

If you or a family member is having trouble with personal funds at a NF, whether the facility is mismanaging the trust account, charging the PNA for items the per-diem covers, refusing to provide quarterly statements, or otherwise violating 42 CFR § 483.10(f)(10), there are several federal and state resources:

National

State Long-Term Care Ombudsman programs

Every state has a Long-Term Care Ombudsman office under the Older Americans Act. The Ombudsman is the resident's direct advocate for facility-level issues, including PNA mismanagement. Contact the National LTC Ombudsman Resource Center for your state's office.

Adult Protective Services

If you suspect financial exploitation or theft from a resident's PNA, contact your state's Adult Protective Services. APS investigates elder financial exploitation, including misappropriation of resident trust funds.

State Medicaid agency complaints

Each state Medicaid agency accepts complaints about facility billing practices. The agency can refer for survey-side enforcement (F570/F571) and may issue civil monetary penalties.

State Attorney General Consumer Protection Divisions

For pattern-and-practice misappropriation across multiple residents (rare but documented), state Attorneys General may bring civil enforcement.

Brevy federal hubs:

Brevy state PNA deep guides:

Find personalized help with Medicaid Personal Needs Allowance at brevy.com.

Last verified: 2026-05-04. This guide reflects 2026 figures. Federal floor: $30/month individual, $60/month couple, frozen since 1988. State figures range from $30 (Alabama) to $200 (Alaska). The PNA Modernization Act (H.R. 5685, 119th Congress) is pending in House Energy & Commerce; if enacted, it would double the federal floor.

BC

Brevy Care Team

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