Washington Medicaid Personal Needs Allowance (2026): What You Keep

Washington Medicaid lets a nursing-facility resident keep a Personal Needs Allowance of $108.74 a month in 2026.1 That money is the resident's to hold back for personal expenses instead of turning it over to the facility: a small slice of monthly income set aside before the rest goes toward the cost of care. At more than three times the federal minimum of $30 a month, Washington's figure protects meaningfully more than a state sitting at the floor.2

In This Guide

• What Is the Washington Medicaid Personal Needs Allowance?
• How the Washington Medicaid Personal Needs Allowance Compares to the Federal Floor
• The Resident Trust Fund: How the Money Is Held
• Where the Allowance Fits in the Patient-Liability Math
• What the Facility Must Provide and Cannot Bill to the Allowance
• The VA Pension Cap for Veterans on Medicaid
• Frequently Asked Questions

What Is the Washington Medicaid Personal Needs Allowance?

When someone moves into a nursing facility and Washington Medicaid, known in this state as Apple Health, begins paying for their care, they don't hand the facility a rent check. Instead, most of the resident's own monthly income, their Social Security, a pension, an annuity, flows toward the cost of care, and Medicaid pays the rest. That contribution from the resident's income is called patient liability, and we'll walk through how it's calculated further down.

Before any of that income goes to the facility, though, the resident is allowed to keep a fixed amount each month for personal use. That protected amount is the Personal Needs Allowance, or PNA. It exists because a nursing-facility resident still has expenses the facility doesn't cover: a haircut, new clothes, a phone bill, snacks, a magazine subscription, a birthday gift for a grandchild, a taxi to a medical appointment that isn't a covered ride. Without the allowance, a resident's entire income would be swept toward the facility, leaving nothing for the small choices that make daily life feel like their own.

The allowance is a federal requirement. Every state that runs a Medicaid program has to let institutionalized residents keep at least a minimum amount, and states are free to set their figure higher. Washington does. The Washington State Health Care Authority (HCA) publishes the state's long-term-care income and resource standards each year, with eligibility for aged, blind, and disabled applicants processed through the Department of Social and Health Services (DSHS) Aging and Long-Term Support Administration. For 2026, Washington sets the nursing-facility Personal Needs Allowance at $108.74 per month.1

Who gets it? Any resident whose nursing-facility care is paid by Apple Health and who has income to protect. One clarification matters here: the allowance is a ceiling on what gets protected, not a payment the resident receives. A resident whose total monthly income is less than $108.74, which can happen when Supplemental Security Income (SSI) is the only income, simply keeps all of it and has little or no patient liability to compute.1

How the Washington Medicaid Personal Needs Allowance Compares to the Federal Floor

Federal law sets a minimum every state must honor. Under the Social Security Act and its implementing regulation, a state's Medicaid plan has to let an institutionalized individual keep a Personal Needs Allowance of at least $30 a month, and an institutionalized couple, where both spouses are aged, blind, or disabled, at least $60 a month. Those numbers are a floor, not a ceiling: a state must set its allowance at or above them, and may go higher. The $30 and $60 figures have not moved since the Omnibus Budget Reconciliation Act of 1987 made them effective on July 1, 1988.2

Washington's $108.74 sits well above that floor, more than three and a half times the federal $30 minimum.1,2 Because the federal figure was never indexed to inflation, a state that never raised its own allowance would be leaving residents with the same $30 that was set nearly four decades ago. Washington's higher figure means a resident here keeps meaningfully more of their income for personal use than a resident in a state parked at the federal minimum.

There's a second Washington figure worth knowing. In a Washington state veterans home, the Personal Needs Allowance runs to a higher maximum of $160 per month.1 Read that word carefully. The $160 is the ceiling for that setting, not a flat amount every veterans-home resident receives, and Washington's rule ties the figure a given resident gets to their own circumstances. If your family member is a veteran, ask the facility and the Medicaid caseworker which figure applies to them, because the allowance is one of several ways the math can differ in a state veterans home. The allowance is not the only figure that moves in that setting: the federal $90 VA pension cap covered later in this guide is written not to reach a state veterans home for which the VA makes per diem payments for nursing home care, so a veteran living in one may be outside the cap entirely.4

The Resident Trust Fund: How the Money Is Held

Once a resident is entitled to keep $108.74 each month, a practical question follows: where does the money actually sit? Many residents ask the facility to hold and manage their personal funds, and federal law lays out exactly how a facility has to do that.1

Under the federal nursing-facility requirements, a resident has the right to manage their own money, and a facility cannot force a resident to deposit personal funds with it. But if a resident chooses to let the facility hold the money, the facility becomes a fiduciary and has to follow strict rules. It has to deposit any of a Medicaid resident's personal funds above $50 into an interest-bearing account kept separate from the facility's own operating accounts. It has to keep a full, separate accounting with no commingling of resident money and facility money. It has to make each resident's financial record available through quarterly statements and on request. It has to secure all resident funds with a surety bond or another assurance the government finds acceptable. And when a resident dies, it has to convey the funds and a final accounting within 30 days to the person or probate court handling the estate.3

That account is usually called the resident trust fund (some facilities call it a personal-needs account). Here's what that means for a family in practice:

• Ask for the quarterly statement, in writing. Facilities don't always send them without prompting. You're entitled to see every deposit, withdrawal, and running balance.
• Reconcile it against what you know. Match the withdrawals to purchases the resident actually authorized. A charge nobody recognizes is worth questioning right away.
• Watch the balance climb. The allowance is meant to be spent. If it accumulates untouched, it counts as a resource, and a Medicaid resident's countable resources have to stay at or below $2,000 to keep eligibility.1 A resident who banks $108.74 every month without spending it would cross that limit in under two years.
• Get the final accounting. At discharge or death, request the closing statement in writing and keep it.

The point of these rules is protection. A resident's small monthly allowance is exactly the kind of money that can quietly go missing, and the federal accounting requirements exist so that a family can see where every dollar went.

Where the Allowance Fits in the Patient-Liability Math

The Personal Needs Allowance isn't a check the resident receives on top of their income. It's a deduction, one of several the state subtracts from a resident's gross monthly income before deciding how much they owe the facility. Understanding the order helps, because families are often surprised by how little (or how much) ends up as patient liability.

Roughly, the calculation for a Washington nursing-facility resident runs like this:

1. Start with the resident's gross monthly income, Social Security, pensions, annuities, and the like.
2. Subtract the Personal Needs Allowance of $108.74. This is the money the resident keeps for personal use.1
3. Subtract a monthly maintenance needs allowance for a community spouse, if the resident is married and their spouse still lives at home and needs income support. Under the federal spousal-impoverishment rules Washington follows, that spousal allowance ranges from a floor of $2,705.00 per month (effective July 1, 2026) up to a maximum of $4,066.50 per month (effective January 1, 2026).5
4. Subtract certain health-care costs the resident still pays out of pocket, such as a Medicare Part B premium or other non-covered medical expenses.
5. What remains is the patient liability, the amount the resident pays the facility each month toward their care. Medicaid covers the rest.

So the allowance sits near the top of the deduction stack: it comes out first, protecting the resident's $108.74 before spousal and medical deductions are even considered.1 For a single resident with a modest Social Security check and no spouse at home, the allowance may be the largest deduction they get, and most of the rest of their income becomes patient liability.

One note on income levels. Washington uses a Medicaid Special Income Level of $2,982 a month for institutional and waiver eligibility in 2026, and a Medically Needy Income Level of $994 a month for those who qualify through the spend-down path.1 Those figures govern whether a person qualifies for coverage in the first place; the Personal Needs Allowance governs what they keep once they're covered. They're different steps, and it's easy to conflate them.

What the Facility Must Provide and Cannot Bill to the Allowance

A resident's allowance is meant for genuinely personal extras, not for the basics a nursing facility is already paid to deliver. Federal law spells out a list of routine items and services that are built into the facility's daily Medicaid rate, and during a covered stay the facility cannot charge the resident for any of them. That means these can't be quietly billed against the $108.74 allowance either.1,6

Items and services the facility must provide at no charge include:

• Nursing services and the direct care the resident needs day to day
• Meals, snacks, and food and nutrition services
• An activities program
• Room and bed maintenance
• Routine personal hygiene items and services, including hair-hygiene supplies, a comb and brush, bath soap, a razor and shaving cream, a toothbrush and toothpaste, denture adhesive and cleaner, moisturizing lotion, incontinence care and supplies, towels and washcloths, over-the-counter drugs the facility supplies, hair and nail hygiene services, help with bathing, and basic personal laundry6

Because those are covered by the daily rate, the resident's allowance is free for the things the facility genuinely doesn't provide: a preferred brand of toiletry beyond the basics, a salon visit rather than the facility's basic hair service, personal clothing, a phone, a streaming subscription, outings, hobby supplies, and gifts.

If you spot a charge against the resident's trust fund for something on the "must provide" list, question it. A facility that bills a resident's personal funds for basic hygiene items or laundry it's already paid to supply is charging for something it shouldn't. The federal accounting and quarterly-statement rules from the trust-fund section above are exactly what let a family catch it.

The VA Pension Cap for Veterans on Medicaid

Veterans on a Department of Veterans Affairs (VA) pension, the needs-based benefit for wartime veterans with limited income, hit a special federal rule when they enter a Medicaid-paying nursing facility, and it interacts with the Personal Needs Allowance in a way worth understanding.

Under federal law, when a veteran who has neither a spouse nor a child is covered by Medicaid for nursing-facility care, no more than $90 a month of VA pension may be paid to the veteran for any period after the month they're admitted. In other words, for that single, childless veteran the pension is capped at $90 once Medicaid is paying for the nursing home. Note both halves of that: the rule is scoped to a veteran with neither a spouse nor a child, and $90 is a ceiling rather than a set amount, so a pension already below $90 is not raised to it.4

There is a third piece, and in Washington it is the one families are most likely to miss, because the cap carries its own definition of the setting it reaches. For purposes of this cap, federal law defines a nursing facility as one covered by the Medicaid nursing-facility requirements, other than a state home for which the VA makes per diem payments for nursing home care. A single, childless veteran whose Medicaid-covered care is delivered in a state veterans home for which the VA makes those per diem payments therefore falls outside the $90 cap, and the cap should not be applied to that setting.4

Here's the part that matters for the resident's pocket. That $90 is not swept into patient liability. Federal law separately provides that the Medicaid payment a nursing facility receives cannot be reduced by the amount of pension the veteran is permitted to keep, so the $90 stays with the veteran rather than flowing to the facility.4

The Personal Needs Allowance and the $90 VA pension come from two different bodies of law: the allowance is set by Washington's Medicaid rules, and the cap is set by federal veterans law. What the federal cap does not settle is whether the veteran ends up holding that $90 on top of Washington's allowance or in place of it. That interaction is a state post-eligibility question, states answer it in opposite directions, and it isn't safe to assume in either direction here.4 If your family member is a single, childless veteran on both a VA pension and Apple Health nursing-facility care, ask the caseworker how the pension is being counted, and check the patient-liability figure on the eligibility notice, which is where the answer shows up.

This is also where the state-veterans-home figure from earlier in this guide meets the pension rule, and the two answers together decide the money. If your family member's Medicaid-covered care is in a Washington state veterans home for which the VA makes per diem payments for nursing home care, the $90 cap does not reach that setting at all, and the allowance side of the math runs on Washington's separate $160 maximum for veterans homes rather than the $108.74 figure.4,1 So ask the home's business office whether the VA pays a per diem for your family member's nursing home care, and ask the Medicaid caseworker which allowance figure they've applied. Those are two different offices and two different answers, and a family that gets only one of them is planning on half the picture.

For married veterans, or veterans with a dependent child, the $90 cap may not apply the same way, and the type of VA benefit matters.4 A veteran's family should raise the specifics with both a Veteran Service Officer and their Medicaid caseworker rather than assume the single-veteran rule fits their situation.

Learn More

Find personalized help understanding the Washington 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.