Medicaid Personal Needs Allowance Explained: Federal Guide

The Medicaid Personal Needs Allowance (PNA) is the one amount of monthly income a nursing-facility resident keeps for personal use after the rest goes to the facility as patient liability. The federal floor is $30 per month, set in 1988 and unchanged since, and in 2026 states range from $30 (Alabama) to $200 (Alaska).1 Almost everything else a Medicaid resident receives each month flows to the nursing home; the PNA is the carve-out federal law reserves for clothing, haircuts, toiletries, phone, and the small dignities the per-diem rate does not cover.

The PNA is one of the most misunderstood numbers in long-term care. In 2025 and 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.

In This Guide

• 60-second version
• The Medicaid Personal Needs Allowance: what it is and what it covers
• The federal statute and regulations behind the PNA
• The federal floor and its 38-year freeze
• The post-eligibility deduction order (with worked example)
• Resident Trust Fund and federal mechanics
• The Medicaid Personal Needs Allowance across care settings: NF, ICF/IID, ALW, HCBS, PACE, hospice
• Complete 2026 state-by-state PNA table
• How states comply and vary across four typologies
• VA pension and the federal cap, stacking and substitution
• Medicare Part B and Part D premium interaction
• The PNA at death and estate recovery
• The PNA Modernization Act (H.R. 5685)
• Why the floor is not enough: the case for raising it
• Brevy state pillars
• Common misconceptions and pitfalls
• Where to get help
• Learn More

The Medicaid Personal Needs Allowance: What It Is and What It Covers

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, federally set at no less than $30 per month.1

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 a modest per-visit fee; 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 typical 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.

The Federal Statute and Regulations Behind the PNA

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)1

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.1

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 ($994/month for 2026) and 300% SSI FBR ($2,982/month).4
• 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.1

Brief history

What $30 in 1988 is worth today

The $30 floor has never been indexed to inflation, and it has not moved since OBRA-87 made it effective on July 1, 1988, so its real purchasing power has eroded steadily across those 38 years.1 Advocacy organizations that track the figure, including Justice in Aging, the National Consumer Voice for Quality Long-Term Care, the AARP Public Policy Institute, and Dignity Alliance Massachusetts, argue that restoring the dignity floor Congress set in OBRA-87 would require a substantially higher individual allowance. Published inflation-adjusted estimates vary with the price series and base month used, so treat any specific restored-value figure as an advocacy estimate rather than a statutory amount. The only amounts that carry legal force are the $30 individual and $60 couple minimums.

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 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 the lowest-PNA states (Alabama at $30, California at $35, Arkansas at $40) without basic dignity.1
4. Cost-shift visibility. Because raising the PNA reduces patient liability and increases state Medicaid nursing-facility outlays (the resident contributes less toward the per-diem; the state share rises proportionally), each dollar of PNA increase multiplied across a state's nursing-facility Medicaid census adds up to a meaningful annual cost-shift from resident to state budget. State legislatures see that cost-shift; they don't always see the unmet personal needs of residents.

The 2025-2026 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 lets a working resident deduct up to an additional $65/month of earned income).
2. Maintenance needs of the community spouse, the Community Spouse Monthly Income Allowance (CSMIA). The institutionalized spouse may shift income to the community spouse to bring that spouse's own monthly income up to the state's Minimum Monthly Maintenance Needs Allowance (MMMNA). The MMMNA is a floor of $2,705.00/month, effective 7/1/2026 through 6/30/2027 (higher in Alaska and Hawaii), and the maximum monthly maintenance needs allowance a state may set is $4,066.50/month, effective 1/1/2026. The allowance may be raised above that maximum by court-ordered support or a fair hearing.5
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)6
   • Medicare Part D premium (the 2026 national base beneficiary premium is $38.99/month; many NF residents pay $0 via the Low-Income Subsidy)7
   • 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 (illustrative): 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 the 2026 standard $202.90/month from her SS check). She kept her Medigap Plan G ($165/month). She has a Part D premium ($45/month, she is in a Standard Plan, not LIS-eligible because she has the small pension). No community spouse. No dependents. PNA: Florida $160 (illustrative; confirm against the FL Medicaid rule).6

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 $160.1

Same example, Alabama instead

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: Alabama sits at the $30 federal floor while Florida sets a far higher figure.1

Resident Trust Fund and 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 other assurance satisfactory to the Secretary of HHS, securing all resident personal funds it holds.
8. Conveyance within 30 days at death. Upon the resident's death, the facility must convey the funds and a final accounting within 30 days to the individual or to the probate jurisdiction administering the resident's estate. (Personal funds are returned to a resident who leaves the facility as well; the 30-day deadline the federal rule states is the one that runs from death.)8

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.8

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 (a common PNA expenditure, billed at the facility's posted per-visit rate)
• 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

The Medicaid Personal Needs Allowance Across Care 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).1

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

The same federal $30 floor applies under the same regulatory provisions. State implementation varies, and 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.1

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.4
• The resident keeps the ALMNA for actual community living expenses, telephone, clothing, medications, ancillary services, transportation, personal items.

Examples (illustrative; confirm each against the state's current rule):

• Ohio ALW (OAC 5160:1-6-08): $994 SSI FBR − $944 R&B cap = $50 ALMNA. (Notably NOT raised alongside Ohio's NF PNA increase to $75, 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.4

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 ceiling on a state's Special Income Limit, $2,982/month for 2026, which is 300% of the $994 SSI FBR):4

• 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.4

The HCBS maintenance allowance is mathematically distinct from institutional PNA and frequently produces lower or zero patient liability for HCBS recipients vs. 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 nursing facility (a small share of the 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. The highest-stakes figures are verified directly against state Medicaid agency .gov rule pages: the Alabama $30 figure is the statutory federal floor under 42 USC § 1396a(q)(2) and 42 CFR § 435.725(c) (tier 0); the Ohio $75 figure is confirmed verbatim in Ohio Administrative Code 5160:1-6-07 (tier 1); the Pennsylvania $60 figure traces to the PA Long-Term Care Handbook Ch. 468.3 (tier 1).1 The remaining state figures are drawn from the National Consumer Voice 2025 chart (a national advocacy non-profit, tier 3) and GotLTCi's January 2026 update (a commercial source, tier 4), with state Medicaid agency rule pages used as the tiebreaker where the two aggregators disagree. Treat any figure carrying a "verify" caveat below as advisory until confirmed against the state's own rule page. Where states have separate ALW or HCBS allowances, see the Personal Needs Allowance across care settings section above and the linked state deep guides.

Highest PNA tier

Mid-tier, $70–$99

Mid-low tier, $50–$69

Lowest tier, $30–$49

Recent state increases (2024-2026)

The 2025 wave shifted the national distribution:

• Ohio: $50 → $75 eff. 1/1/2026, by administrative rulemaking under OAC 5160:1-6-07 (the immediately prior version of the same rule, effective 6/1/2025, still read "fifty dollars"). Ohio's statutory floor in ORC 5163.33(B) was not amended and still reads not less than $50 for an individual resident, so the $75 is an operational figure ODM set above that floor by rule.3
• 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 Across 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.)1

"Indexed" states, peg to SSI FBR or formula

A minority of states formally index PNA to a federal benchmark (figures illustrative; confirm against each state's rule):

• Arizona ($149.10, a percentage of the SSI FBR plus a state supplement)
• Maryland ($106, partially indexed)
• Vermont ($79.93, partially indexed)4

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)3
• 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)
• Mississippi: $44 standard / $90 for VA pension recipients, in place of the $4411
• 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): a nursing-facility resident with earned income may deduct up to an additional $65/month of that earned income beyond the $75 PNA. The $65 is a ceiling on the deduction, not a flat add-on.3
• 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)1

(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, Stacking and Substitution

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 veteran with neither spouse nor child on Medicaid NF coverage, under 38 USC § 5503(d) the VA pays no more than $90/month in pension for any period after the month of admission to the nursing facility. Under § 5503(d)(5)(A) the same rule reaches a surviving spouse with no child in that situation. The cap is on the VA pension total (the needs-based benefit), so an Aid and Attendance (A&A) or Housebound amount paid as part of that pension sits inside the $90 rather than on top of it.2

Two related exclusions run the other way, in the resident's favor, when Medicaid counts income for eligibility and patient liability: A&A and Housebound allowances are not counted as income under the SSI methodology Medicaid uses for the aged, blind, and disabled, and any portion of a VA pension paid as reimbursement of unreimbursed or unusual medical expenses is likewise excluded.2

How the $90 relates to the state PNA: stacking, or substitution

Federal law does exactly two things here, and neither one is the thing most families (and most websites) assume. § 5503(d)(2) caps the pension at $90. § 5503(d)(3) shields the facility's payment: the amount Medicaid pays the nursing home "may not be reduced by any amount of pension permitted to be paid" under the cap, so a state cannot quietly recoup the $90 by paying the home less. Read the object of that second rule carefully. It governs what the state pays the facility, an anti-offset rule, and it says nothing about what the resident holds alongside a state personal needs allowance. The word "personal" does not appear anywhere in 38 USC § 5503, and VA's own guidance describes the $90 as an amount that may be higher than the personal spending allowance a state's Medicaid program provides, a comparison that only makes sense if the two can be alternatives.2

So the federal statute caps and shields. Whether that $90 sits on top of your state's PNA or takes its place is your state's rule, and states answer it both ways. Georgia is the clearest documented substitution: its DFCS post-eligibility chart assigns one PNA per recipient category, instructing the worker to use the listed amount "as the PNA in the Patient Liability/Cost Share Budget," and a VA pensioner or surviving spouse in a nursing home with no dependents is assigned $90, replacing the $70 row rather than adding to it. The chart adds that "the VA check for these individuals is reduced to the amount of the PNA, regardless of other income," so in Georgia the PNA and the VA check are the same money: that veteran keeps $90, not $70 + $90. A Georgia VA pensioner with dependents gets the standard $70.3

Other states reach the opposite result, and by a route worth understanding, because it is a rule about income, not about the PNA. Ohio excludes "Veterans administration pensions, including payments for aid and attendance, up to the amount of ninety dollars per month" from countable income for a veteran with no spouse or dependent minor or disabled child (and for that veteran's surviving spouse) under OAC 5160:1-6-07. Because the $90 never enters countable income, the PNA is deducted from the resident's other income and the $90 survives on top of it.2 Tennessee does the same by manual: TennCare's Aged, Blind and Disabled chapter lists "VA pensions limited to $90 per month" among income "not included in total income," so the $70 PNA comes out of other income and a qualifying resident holds both. One honest caveat on that arithmetic: if the capped pension is the resident's only income, there is nothing for the PNA deduction to draw from, and $90 is what they have.1

So do not add a state's headline PNA to the $90 without checking that state's own rule. Count what is actually known: Brevy has verified this interaction in five states. Three substitute (Georgia, Michigan, Mississippi, below); two reach a stacking result through an income exclusion (Ohio, Tennessee). The other forty-five states, and the District of Columbia, are unverified, and an unverified state is not evidence for either pattern. The state table above lists standard PNAs only. If your state is not one of the five, the answer is in its own post-eligibility manual, not in the federal statute.2

The $90 the veteran keeps is deposited to the Resident Trust Fund account and is governed by the same 42 CFR § 483.10(f)(10) protections as the state PNA.8

Veterans with a spouse or a child

If the veteran is married or has a 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).5

This is a meaningful difference: a Korea-era veteran with neither spouse nor child in an Ohio NF has the pension itself cut to $90; a married Vietnam-era veteran in the same NF keeps drawing his full pension, which then runs through the patient-liability budget like any other income, with the $75 PNA and the spouse's MMMNA protected out of it.2

State-level interactions

These are the five states whose rule Brevy has verified. Three set a different PNA for VA pension recipients, and in each the special figure is the PNA, what the resident keeps, not an amount added to the standard PNA:

• Georgia: a VA pensioner or surviving spouse in a nursing home with no dependents is assigned $90 as the PNA, replacing the $70 standard row, and the VA check is reduced to that amount regardless of other income. With dependents, the standard $70 applies.3
• Michigan: the standard $60 personal allowance rises to $90/month for a veteran receiving a VA Improved Pension, per the MDHHS Bridges Eligibility Manual.5
• Mississippi: veterans and surviving spouses of veterans who receive a $90 VA pension have a $90 PNA rather than the $44 standard, per the Mississippi Division of Medicaid.11

Two get to the other answer without touching the PNA at all, by excluding the capped pension from income before the PNA step:

• Ohio: OAC 5160:1-6-07 excludes the VA pension up to $90/month from countable income for a veteran with no spouse or dependent minor or disabled child, and for that veteran's surviving spouse, so the $75 PNA is deducted from other income and the $90 stands on top.2
• Tennessee: TennCare's Aged, Blind and Disabled manual puts "VA pensions limited to $90 per month" in the list of income "not included in total income," leaving the $70 PNA intact alongside it. TennCare applies its $90 limit to a wider group than the federal statute does, and carves out HCBS and state veterans homes.1

Keep three ideas distinct when you read a state manual. The federal $90 is a ceiling on the pension VA may pay. The federal anti-offset rule protects the facility's Medicaid payment from being cut by that $90. A state PNA is an amount the state must protect out of the resident's income. A state that pegs its PNA to $90 has collapsed the first and third into one figure; a state that excludes the pension from income has kept them separate. That choice, not the federal statute, is what decides the arithmetic.2

Medicare Part B and Part D Premium Interaction

2026 Medicare Part B

CMS announced on November 14, 2025 that the standard 2026 Medicare Part B premium is $202.90/month (up from $185.00 in 2025) with an annual deductible of $283. Income-Related Monthly Adjustment Amount (IRMAA) brackets above the standard rate apply for higher-income beneficiaries.6

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, income at or below 100% FPL): The state pays the Part A and Part B premiums and all Medicare cost-sharing. There is no Part B deduction in the post-eligibility calculation. The PNA still applies in full.
• SLMB (Specified Low-Income Medicare Beneficiary, income 100–120% FPL): The state pays the Part B premium only. No deduction; PNA in full.
• QI (Qualifying Individual, income 120–135% FPL): The state pays the Part B premium only. QI is not available to someone who also has full Medicaid, so a nursing-facility resident receiving full Medicaid benefits (and therefore a PNA) is enrolled through QMB or SLMB rather than QI. QI is also granted first-come, first-served from limited annual funding, and has to be reapplied for every year; qualifying once does not carry you into the next year.
• Full-Benefit Dual-Eligible (FBDE): Almost always also QMB, the state pays Part B. PNA in full.13

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.13

Part D and the Low-Income Subsidy

Medicare Part D premiums vary by plan; the 2026 national base beneficiary premium is $38.99/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.7

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.

The PNA at Death 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 individual administering the resident's estate (executor or administrator)
• The probate jurisdiction administering the estate, once probate is opened
• A surviving spouse or other next of kin only where state law puts them in that administering role, or where the balance passes outside probate under the small-estate route below

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, because a resident's countable resources are kept below the Medicaid resource limit (commonly $2,000 for an aged, blind, or disabled recipient) during life. Common dispositions:14

• 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. Thresholds vary by state and change with statute, so confirm the current figure with the state's probate code; examples include Texas (Estates Code § 205.001), California (Probate Code § 13100), New York (SCPA § 1301), Florida (F.S. § 735.301), Pennsylvania (20 Pa. C.S. § 3102), and Ohio (ORC § 2113.03 and § 2113.031).

Estate recovery treatment

Under 42 USC § 1396p(b)(1), states must seek recovery from the estate of a deceased recipient who was 55 or older when they received nursing-facility services, home and community-based services, or related hospital and prescription-drug services, and from a recipient of any age who was permanently institutionalized. Recovery may be made only after the death of a surviving spouse, and only when there is no surviving child who is under 21 or who is blind or permanently and totally disabled. Every state must also establish procedures to waive recovery in cases of undue hardship.14 Approximately 25 states extend recovery to non-probate transfers ("expanded recovery"), Ohio, Iowa, Pennsylvania, Indiana, and others. The remaining states are probate-only; Massachusetts narrowed its program to the federal-floor, probate-only minimum under Chapter 197 of the Acts of 2024 (applying to estates of MassHealth members who died on or after August 1, 2024), and Tennessee uses a probate-only definition with a $25,000 minimum estate threshold under TCA § 71-5-116.

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

• Federal bars on recovery: a surviving spouse (recovery is deferred until after that spouse's death), a surviving child under 21, or a surviving child of any age who is blind or permanently and totally disabled
• State hardship waivers under 42 CFR § 433.36(h): every state must have a process (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: some states waive recovery on small estates below a set dollar threshold (for example, Pennsylvania and Florida each set a low de minimis floor); confirm the current figure with the state program
• State-specific carve-outs: caregiver child residing in home; sibling continuity exception (with prior equity interest); long-term occupant exception14

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.14

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/month1

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 7682.1

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 2025-2026 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 a successor) eventually passes, it would only raise the floor, so states already at $60 or above would be unaffected. Practically, it would matter most for the lowest-PNA states, Alabama ($30), California ($35), and the others in the lowest tier of the state table above.1

Why $30 Is Not Enough: The Case for Raising the Federal Floor

The core dignity argument

Consider a widow in an Alabama nursing facility living on the $30 federal floor. In a single month, one haircut at the in-house salon can consume her entire allowance, leaving nothing for a replacement pair of shoes, a phone card to call a grandchild, or a new package of her preferred toiletries. The next month she chooses again between the same handful of small needs. That is the practical reality the PNA is meant to prevent, and at $30 it often cannot.1

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 at the facility salon
• 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, a figure unchanged since 1988 and worth far less today after decades of inflation. A single haircut can cost more than the entire monthly PNA. A sweater or pair of shoes costs more. A month of basic cell phone service costs more.1

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 roughly sixfold differential in personal allowances based purely on geography, $30 in Alabama versus $200 in Alaska, for residents with otherwise identical incomes, identical facility costs, and identical Medicare premiums. Two Medicaid recipients in nursing facilities across a state line from each other can have radically different monthly personal funds.1

Counter-arguments

State Medicaid administrators raise three main concerns:

1. Cost shift: Every dollar of PNA increase, multiplied across a state's nursing-facility Medicaid census, shifts cost from the resident's share to the state Medicaid budget.
2. State autonomy: The federal floor is a baseline; states are free to raise it. Some argue a federal increase is unnecessary.
3. Operational complexity: State Medicaid systems must reprogram for any federal floor change; states already well above the floor 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.

• Alabama: Personal Needs Allowance deep guide | Alabama Medicaid pillar
• Alaska: Personal Needs Allowance deep guide | Alaska Medicaid pillar
• Arizona: Personal Needs Allowance deep guide | Arizona Medicaid pillar
• Arkansas: Personal Needs Allowance deep guide | Arkansas Medicaid pillar
• California: Personal Needs Allowance deep guide | California Medicaid pillar
• Colorado: Personal Needs Allowance deep guide | Colorado Medicaid pillar
• Connecticut: Personal Needs Allowance deep guide | Connecticut Medicaid pillar
• Delaware: Personal Needs Allowance deep guide | Delaware Medicaid pillar
• District of Columbia: Personal Needs Allowance deep guide | District of Columbia Medicaid pillar
• Florida: Personal Needs Allowance deep guide | Florida Medicaid pillar
• Georgia: Personal Needs Allowance deep guide | Georgia Medicaid pillar
• Hawaii: Personal Needs Allowance deep guide | Hawaii Medicaid pillar
• Idaho: Personal Needs Allowance deep guide | Idaho Medicaid pillar
• Illinois: Personal Needs Allowance deep guide | Illinois Medicaid pillar
• Indiana: Personal Needs Allowance deep guide | Indiana Medicaid pillar
• Iowa: Personal Needs Allowance deep guide | Iowa Medicaid pillar
• Kansas: Personal Needs Allowance deep guide | Kansas Medicaid pillar
• Kentucky: Personal Needs Allowance deep guide | Kentucky Medicaid pillar
• Louisiana: Personal Needs Allowance deep guide | Louisiana Medicaid pillar
• Maine: Personal Needs Allowance deep guide | Maine Medicaid pillar
• Maryland: Personal Needs Allowance deep guide | Maryland Medicaid pillar
• Massachusetts: Personal Needs Allowance deep guide | Massachusetts Medicaid pillar
• Michigan: Personal Needs Allowance deep guide | Michigan Medicaid pillar
• Minnesota: Personal Needs Allowance deep guide | Minnesota Medicaid pillar
• Mississippi: Personal Needs Allowance deep guide | Mississippi Medicaid pillar
• Missouri: Personal Needs Allowance deep guide | Missouri Medicaid pillar
• Montana: Personal Needs Allowance deep guide | Montana Medicaid pillar
• Nebraska: Personal Needs Allowance deep guide | Nebraska Medicaid pillar
• Nevada: Personal Needs Allowance deep guide | Nevada Medicaid pillar
• New Hampshire: Personal Needs Allowance deep guide | New Hampshire Medicaid pillar
• New Jersey: Personal Needs Allowance deep guide | New Jersey Medicaid pillar
• New Mexico: Personal Needs Allowance deep guide | New Mexico Medicaid pillar
• New York: Personal Needs Allowance deep guide | New York Medicaid pillar
• North Carolina: Personal Needs Allowance deep guide | North Carolina Medicaid pillar
• North Dakota: Personal Needs Allowance deep guide | North Dakota Medicaid pillar
• Ohio: Personal Needs Allowance deep guide | Ohio Medicaid pillar | Ohio Estate Recovery | Ohio Eligibility & Income Limits | Next Generation MyCare Ohio
• Oklahoma: Personal Needs Allowance deep guide | Oklahoma Medicaid pillar
• Oregon: Personal Needs Allowance deep guide | Oregon Medicaid pillar
• Pennsylvania: Personal Needs Allowance deep guide | Pennsylvania Medicaid pillar
• Rhode Island: Personal Needs Allowance deep guide | Rhode Island Medicaid pillar
• South Carolina: Personal Needs Allowance deep guide | South Carolina Medicaid pillar
• South Dakota: Personal Needs Allowance deep guide | South Dakota Medicaid pillar
• Tennessee: Personal Needs Allowance deep guide | Tennessee Medicaid pillar
• Texas: Personal Needs Allowance deep guide | Texas Medicaid pillar
• Utah: Personal Needs Allowance deep guide | Utah Medicaid pillar
• Vermont: Personal Needs Allowance deep guide | Vermont Medicaid pillar
• Virginia: Personal Needs Allowance deep guide | Virginia Medicaid pillar
• Washington: Personal Needs Allowance deep guide | Washington Medicaid pillar
• West Virginia: Personal Needs Allowance deep guide | West Virginia Medicaid pillar
• Wisconsin: Personal Needs Allowance deep guide | Wisconsin Medicaid pillar
• Wyoming: Personal Needs Allowance deep guide | Wyoming Medicaid pillar

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." A veteran with neither spouse nor child doesn't. 38 USC § 5503(d) caps the VA pension of a veteran with neither spouse nor child at $90/month for any period after the month of admission to a Medicaid-covered nursing facility. Federal law also stops the state recouping that $90 by paying the facility less, but it does not say whether the $90 rides on top of the state PNA: that is a state rule. Verified states split. Ohio and Tennessee exclude the capped pension from income, so their PNA survives alongside it; Georgia, Michigan and Mississippi make $90 the PNA, so it is not added to the standard figure at all. A veteran with a spouse or a child is 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 NF increase to $75, effective 1/1/2026, 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. To reach your state's office, contact the National LTC Ombudsman Resource Center or call the federal Eldercare Locator at 1-800-677-1116, which routes callers to their local ombudsman program.

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.

Learn More

Find personalized help with the Medicaid 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.