South Carolina Medicaid Personal Needs Allowance (2026)

$60 a month is what South Carolina Medicaid lets a nursing home resident keep for personal spending, an amount called the Personal Needs Allowance. If your parent or spouse is in a nursing facility and Medicaid is paying the bill, almost all of their monthly income goes to the facility, but this small slice is protected by law and stays theirs to spend on the things Medicaid and the facility don't cover.1

In This Guide

• What Is the South Carolina Medicaid Personal Needs Allowance?
• How South Carolina's Medicaid Personal Needs Allowance Compares to the Federal Floor
• How the Resident Trust Fund Holds the Money
• Patient Liability: Where Your Allowance Fits in the Math
• What the Facility Must Provide and Can't Bill to You
• Veterans and the VA Pension Cap
• Frequently Asked Questions

What Is the South Carolina Medicaid Personal Needs Allowance?

When someone moves into a nursing facility and Medicaid pays for their care, they don't hand a rent check to the facility each month. Instead, Medicaid pays the facility directly, and the resident is expected to contribute nearly all of their own monthly income, their Social Security check, any pension, and most other income, toward the cost of that care. The amount they contribute is called their patient liability or share of cost.

Federal law doesn't let the facility take everything, though. Every nursing home resident on Medicaid gets to hold back a small, fixed amount each month for personal expenses. That protected amount is the Personal Needs Allowance, usually shortened to PNA. It exists so that a resident isn't left with nothing of their own, no way to buy a birthday card, a haircut, a favorite snack, or a phone plan without asking the facility for permission.

In South Carolina, the Medicaid program is called Healthy Connections, and it's administered by the South Carolina Department of Health and Human Services (SCDHHS). For a resident of a nursing facility, South Carolina sets the Personal Needs Allowance at $60 per month in 2026. A resident who takes part in a work therapy program as part of their plan of care is allowed $100 per month instead.1

Who gets it? Any Medicaid recipient living in a nursing facility whose income is being counted toward the cost of their care. The allowance is deducted from their income before the state calculates how much they owe the facility, so it comes off the top rather than being something they have to claw back afterward. Health insurance premiums the resident pays are a further allowable deduction, but be careful with a common assumption here: South Carolina's policy specifically excludes Medicare Part A and Part B premiums from that deduction, so a dual-eligible resident should not expect a Part B premium to come off their patient liability.1

How South Carolina's Medicaid Personal Needs Allowance Compares to the Federal Floor

Federal law sets a minimum that every state has to meet. Under 42 U.S.C. 1396a(q) and 42 CFR 435.725, the Personal Needs Allowance floor is $30 a month for an institutionalized individual and $60 a month for an institutionalized couple when both spouses are aged, blind, or disabled. Those figures haven't changed since they took effect in July 1988. States are free to set their allowance higher, but none may go below the floor.2

South Carolina spent decades at that federal minimum of $30. Effective October 1, 2025, SCDHHS doubled it to $60, which is where it stands for 2026. So a single South Carolina nursing home resident now keeps twice what the federal floor requires, and their monthly allowance happens to equal the amount federal law reserves for a couple.1,2

Here's how the 2026 figures line up.

The practical takeaway is a good one for South Carolina families: the state raised the amount its residents keep, and $60 goes noticeably further than the $30 that stood for so long. It still isn't a lot of money, so planning how it's spent and held matters, which is what the rest of this guide covers.1

How the Resident Trust Fund Holds the Money

Once the allowance is protected, the next question families ask is a practical one: where does the money actually sit, and who controls it? Most residents let the facility hold their personal funds in what's usually called a resident trust fund account, and federal rules under 42 CFR 483.10(f)(10) spell out exactly how the facility has to handle it.

A few points are worth knowing, because they're your protections as a family:

• The facility cannot require a resident to deposit their personal funds with it. A resident may keep and manage their own money if they prefer. If they do ask the facility to hold it, the facility has to act as a fiduciary.3
• For a Medicaid resident, any balance over $50 has to go into an interest-bearing account that's separate from the facility's own operating accounts, and the interest belongs to the resident.3
• The facility must keep a full, separate accounting with no commingling of resident money and facility money, and it must give the resident quarterly statements and access to the record on request.3
• It must protect the funds with a surety bond or another assurance acceptable to the federal government, so the money is recoverable even if the facility runs into financial trouble.3
• When a resident dies, the facility has to convey the remaining funds and a final accounting within 30 days to the person or probate court handling the estate.3

A simple habit protects your loved one here: ask for the quarterly statement every quarter rather than waiting for it to arrive, and reconcile it against what you know was actually spent. If the numbers don't match, that's worth raising with the facility administrator right away.

Patient Liability: Where Your Allowance Fits in the Math

The Personal Needs Allowance makes the most sense when you see the whole calculation it sits inside. In South Carolina, a nursing home resident on Medicaid contributes their income to the cost of care in a set order, and the allowance comes out near the top.

The state starts with the resident's gross monthly income, then subtracts a series of protected amounts. What's left over after those deductions is the patient liability, the check that effectively goes to the facility each month. The main deductions, in plain terms, are:

1. The $60 Personal Needs Allowance, kept by the resident.1
2. Health insurance premiums the resident pays. South Carolina excludes Medicare Part A and Part B premiums from this deduction.1
3. A monthly income allowance for a spouse still living at home, if the resident is married and the community spouse's own income falls short. This spousal maintenance allowance is set under federal spousal-impoverishment rules and worked out case by case.
4. Certain remaining medical costs the resident is responsible for that Medicaid doesn't cover.

Everything above those deductions goes to the facility. So the allowance isn't a bonus the resident receives on top of their income, it's income they're allowed to hold back before the rest is spent on care.

Two other South Carolina figures shape this picture. To qualify for nursing facility Medicaid in the first place, a single applicant is limited to $2,000 in countable assets (or $9,950 for an applicant who can qualify under the state's aged, blind, or disabled criteria), and their income has to fall at or below the state's institutional limit of $2,982 per month in 2026 (an applicant over that line can still qualify by setting up an income trust, often called a Miller trust, and depositing their income into that account each month). Those limits govern eligibility, while the Personal Needs Allowance governs what a resident keeps once they're on the program.1

One thing to watch: because the resident trust fund balance is a countable asset, letting the $60 pile up untouched month after month can eventually push a resident toward that $2,000 asset limit. Spending the allowance down each month, on real personal needs, keeps that from becoming a problem.1,3

What the Facility Must Provide and Can't Bill to You

A common and costly misunderstanding is that the Personal Needs Allowance is supposed to cover everyday care items. It isn't. Federal law already requires the facility to provide a long list of routine items and services as part of the daily rate Medicaid pays, and under 42 CFR 483.10(f)(11) the facility may not charge the resident for any of them during a covered stay. That means they can't be billed against the $60 allowance either.5

Included in what the facility must provide at no extra charge:

• Nursing services and personal care.5
• Meals and nutrition services.5
• An activities program and room and bed maintenance.5
• Routine personal hygiene items and services, including things like a comb, brush, bath soap, razor and shaving cream, toothbrush and toothpaste, denture adhesive, moisturizing lotion, incontinence care and supplies, towels and washcloths, basic personal laundry, and routine hair and nail care.5

So the allowance is meant for the extras that make a place feel like a person's own: clothing, a preferred brand of shampoo, salon visits beyond basic hair care, magazines, hobby supplies, phone and streaming plans, snacks and outings, and gifts for family. If a facility tries to charge the resident's personal funds for a service that's supposed to be part of the daily rate, that's a billing error worth challenging, and the long-term care ombudsman can help sort it out.

Veterans and the VA Pension Cap

Veterans on a VA pension face a rule of their own once Medicaid starts paying for nursing home care, and it's one families often get wrong. The VA pension here is the needs-based benefit, which is different from VA disability compensation.

Under 38 U.S.C. 5503(d)(2), when a veteran who has neither a spouse nor a child is covered by Medicaid for nursing facility care, no VA pension above $90 per month may be paid for any period after the month of admission. In other words, the pension is reduced to $90 while Medicaid is footing the nursing home bill.4

The part that matters most for families is what happens to that $90. Federal law also says the Medicaid payment the facility receives may not be reduced by the pension the veteran is allowed to keep, so Medicaid can't claw the $90 back through what it pays the home. That's an anti-offset rule about the facility's reimbursement, though, and it stops there.4

What federal law does not settle is whether that $90 sits alongside South Carolina's $60 Personal Needs Allowance or serves as the veteran's personal spending money in place of it. That question is answered by state post-eligibility rules, and states answer it in both directions. We have not confirmed South Carolina's answer against a published state rule, so don't plan around either version. Ask South Carolina Healthy Connections Medicaid (SCDHHS) or the resident's eligibility worker how the pension is treated in the patient liability calculation, and check the patient liability notice, which shows what is actually being deducted.4,1

For a married veteran or one with a dependent child, the $90 cap may not apply the same way, and the interaction with spousal-income rules gets more involved. A veteran in that situation should talk through the numbers with both a County Veterans Affairs Officer and a Medicaid eligibility worker before assuming any figure.4

Learn More

Find personalized help understanding South Carolina Medicaid nursing home rules 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.