Washington Medicaid lets a nursing-facility resident keep a Personal Needs Allowance of $108.74 a month in 2026. 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 state works out how much of 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.

In This Guide

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, far more of a resident's income would be swept toward the facility, leaving little or 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) administers Apple Health and publishes the state's long-term-care income and resource standards, with long-term-care eligibility processed by the Department of Social and Health Services (DSHS) Home and Community Services, part of its Aging and Long-Term Support Administration. For 2026, Washington sets the standard nursing-facility Personal Needs Allowance at $108.74 per month.

Who gets it? Generally, any resident whose nursing-facility care is paid by Apple Health and who has income to protect. The exception is a resident who receives ABD or TANF cash assistance: that resident keeps the cash program's client personal and incidental payment instead of the $108.74 figure. 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 simply keeps all of it and has no patient liability to compute.

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 at least $60 a month when both spouses are aged, blind, or disabled and their incomes are considered available to each other in determining eligibility. 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 haven't changed since the Omnibus Budget Reconciliation Act of 1987 wrote them into the statute, effective for calendar quarters beginning on or after July 1, 1988.

Washington's $108.74 sits well above that floor, more than three and a half times the federal $30 minimum., Because the federal figure hasn't changed since 1988, 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 is $160 per month (HCA lists it as the state veterans home maximum) for a resident who doesn't receive a needs-based VA pension. A veteran with no spouse or dependent children, or a veteran's surviving spouse with no dependent children, whose needs-based VA pension is over $90 is held to the standard $108.74 figure instead. 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.

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.

Under the federal nursing-facility requirements, a resident has the right to manage their own money, including the right to know in advance what charges the facility may make against their personal funds, and a facility cannot require a resident to deposit personal funds with it. But if a resident chooses to deposit funds with the facility and authorizes it in writing, 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 with facility money or anyone else's, other than another resident's. 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 is discharged, evicted, or dies, it has to convey the funds and a final accounting within 30 days: to the resident, or after a death to the person or probate jurisdiction handling the estate, under state law.

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 single resident's countable resources generally have to stay at or below $2,000 to keep eligibility. A resident who banks $108.74 every month without spending it would cross that limit in under two years. The facility has to warn a Medicaid resident when the account reaches $200 less than the Supplemental Security Income (SSI) resource limit for one person, and that if the account plus the resident's other nonexempt resources reaches that limit, the resident may lose Medicaid or SSI eligibility.
  • 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.
  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, and a maintenance allowance for other family members at home. Under the federal spousal-impoverishment rules Washington follows, the minimum monthly maintenance needs allowance is $2,705.00 per month (effective July 1, 2026) and the maximum is $4,066.50 per month (effective January 1, 2026). A fair hearing can set a higher amount when the at-home spouse needs more income because of exceptional circumstances causing significant financial duress.,,
  4. Subtract medical costs the resident still owes that no third party pays, including Medicare and other health-insurance premiums, deductibles, and coinsurance.
  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 at the top of the deduction stack: it comes out first, protecting the resident's $108.74 before spousal, family, and medical deductions are even considered., 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 a single person, which belongs to the medically needy route that can still open institutional coverage for someone whose income is over the Special Income Level. 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 seven categories of 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.,

The seven categories the facility must provide at no charge during a covered stay are:

  • Nursing services
  • 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, dental floss, deodorant, moisturizing lotion, incontinence care and supplies, towels and washcloths, over-the-counter drugs, hair and nail hygiene services, help with bathing, and basic personal laundry
  • Medically related social services
  • Hospice services the resident elects, when Medicare's hospice benefit or Medicaid pays for them

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. A facility can charge the resident's funds for extras like these only if the resident asked for them, they aren't needed for the goals in the resident's care plan, the facility said up front there would be a charge, and Medicare or Medicaid isn't paying for them.

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 VA's needs-based benefit, 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. Federal law applies the same cap to a surviving spouse with no child and to a child entitled to a survivors pension. And $90 is a ceiling rather than a set amount, so a pension already below $90 is not raised to it.

VA's own regulation words the starting point differently: it limits the pension for any period after the month Medicaid payments begin, rather than after the month of admission. When Medicaid starts paying in the month of admission, those are the same month. When Medicaid approval comes months later, they aren't, so confirm with VA which month the reduction runs from. Either way, federal law says a veteran isn't liable to repay pension the VA failed to reduce, unless the veteran willfully concealed information VA needed to make the reduction.

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.

Federal law also protects the facility side of the ledger: the Medicaid payment a nursing facility receives cannot be reduced by the amount of pension the veteran is permitted to keep, so the retained $90 is not offset against the facility's Medicaid payment.

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, the answer varies by state (Rhode Island, for one, gives a veteran the $90 instead of its own allowance, not on top of it), and it isn't safe to assume in either direction here. 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. The allowance side then turns on the pension itself. Washington's $160 veterans-home figure is for a resident who doesn't receive a needs-based VA pension; a veteran with no spouse or dependent children, or a surviving spouse with no dependent children, whose needs-based pension is over $90 is held to the standard $108.74 figure instead. 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. 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.

Frequently Asked Questions

How much is the Washington Medicaid Personal Needs Allowance in 2026?

A nursing-facility resident on Apple Health generally keeps $108.74 per month in 2026. In a Washington state veterans home a resident who doesn't receive a needs-based VA pension keeps $160 per month, while a single veteran or surviving spouse with no dependent children whose needs-based pension is over $90 is held to the $108.74 figure.

Is the allowance the same as the income limit to qualify for Medicaid?

No. The income limit decides whether a person qualifies for long-term-care coverage in the first place; Washington uses a Special Income Level of $2,982 a month for institutional and waiver eligibility in 2026. The Personal Needs Allowance is a separate figure that governs how much of a resident's income they keep once Medicaid is already paying for their care.

Where is the allowance kept?

Many residents ask the facility to hold their personal funds in a resident trust fund. Federal rules require the facility to keep any balance above $50 in a separate interest-bearing account, provide quarterly statements, secure the funds with a surety bond or similar assurance, and convey the money with a final accounting within 30 days of the resident's discharge, eviction, or death.

Can the facility charge my family member's allowance for soap, laundry, or basic care?

Not for covered items. Nursing services, food and nutrition services, activities, and routine personal hygiene items and services, including basic personal laundry, are included in the facility's daily Medicaid rate, and during a covered stay the facility cannot bill the resident, or the resident's personal funds, for them. The allowance is for personal extras the facility doesn't provide, and the facility can charge for those only when the resident requested them and was told in advance there would be a charge.

My father is a veteran on a VA pension. How does that affect his allowance?

If he's a single veteran with no spouse or child and Medicaid is paying for his nursing-facility care, federal law caps his VA pension at $90 a month, and the facility's Medicaid payment can't be reduced by the $90 he keeps. The setting matters, though: the cap is written not to reach a state veterans home for which the VA makes per diem payments for nursing home care, so a veteran whose Medicaid-covered care is in such a home is outside the $90 cap. Whether a retained pension is held on top of his Personal Needs Allowance or counts in its place is set by Washington's own post-eligibility rules rather than by the federal cap, so ask the eligibility worker how the pension is being counted.

What happens if the allowance builds up in the account?

The allowance is meant to be spent. If it accumulates, it counts toward the resident's countable resources, which for a single resident generally must stay at or below $2,000 to keep Medicaid eligibility. Families should spend the allowance down each month and track the trust-fund balance to avoid crossing that limit.

Learn More

MedicaidWashington Medicaid: A Guide for Seniors and FamiliesWashington Apple Health covers long-term care via HCA and DSHS: $2,000 asset limit, $2,982 income level, medically needy route, $1,130,000 home equity limit. MedicaidWashington Medicaid and Nursing Home CareHow Washington Medicaid nursing home coverage works in 2026: Apple Health eligibility, the asset limit, the income standard, spend-down, and estate recovery. MedicaidYour Guide to Washington Medicaid Income and Asset LimitsWashington Medicaid income limits 2026: 138% FPL and no asset test on the MAGI track, plus the $2,982 special income level and spend-down for long-term care. MedicaidWashington Medicaid Spousal Impoverishment RulesWashington Medicaid spousal impoverishment rules for 2026: the $72,529 to $162,660 CSRA, the $2,705 MMMNA, and when the home equity limit applies. MedicaidHow Washington Medicaid Estate Recovery WorksWashington Medicaid estate recovery reaches non-probate assets, not just probate. How Apple Health recovers from LTC recipients 55 and older, plus protections.

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.

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