West Virginia Medicaid Personal Needs Allowance (2026)

West Virginia Medicaid protects $50 a month as a Personal Needs Allowance for a nursing home resident in 2026, the slice of income the state sets aside for personal spending. When Medicaid pays for someone's nursing facility care, most of their monthly income goes to the facility, but not all of it. That protected $50 is theirs to spend on the things a nursing home doesn't provide.1

In This Guide

• What Is the West Virginia Medicaid Personal Needs Allowance?
• The West Virginia Medicaid Personal Needs Allowance vs. the Federal Floor
• How the Money Is Held: The Resident Trust Fund
• Where the Allowance Fits in Patient Liability
• What the Facility Must Provide and Can't Charge to the Allowance
• How the VA Pension Cap Changes the Allowance
• Frequently Asked Questions
• Learn More

What Is the West Virginia Medicaid Personal Needs Allowance?

When someone moves into a nursing home and West Virginia Medicaid starts paying the bill, the arrangement changes how their income is handled. The resident no longer pays rent, food, or care costs out of pocket, because Medicaid covers those directly. In exchange, most of their monthly income, Social Security, a pension, an annuity, gets counted toward the cost of care and is paid over to the facility each month, after a short list of protected deductions.2 That contribution is called the patient liability, sometimes the share of cost.

The Personal Needs Allowance (PNA) is the exception carved out of that math. Federal law requires every state to let a nursing home resident keep a small, fixed amount of income each month for personal use, so that the resident isn't left with nothing of their own. In West Virginia, that amount is $50 a month for a nursing facility resident.1

Fifty dollars isn't much, and it isn't meant to cover care. It's meant to cover the small dignities a facility doesn't: a haircut at the in-house salon, a favorite brand of lotion, a phone plan, stamps and greeting cards, snacks, a magazine subscription, a small gift for a grandchild. The allowance belongs to the resident, and the resident (or whoever helps manage their affairs) decides how to spend it.

The PNA is part of the post-eligibility math for a West Virginia Medicaid nursing home resident, so it doesn't matter how the person qualified.1 Some people whose income is above the state's maximum when they apply can still become eligible through what the state calls spenddown, and the local Department of Human Services (DoHS) worker explains that process if it applies.4 The allowance itself is set in West Virginia's Income Maintenance Manual, in the nursing-facility section listing what may be deducted from a resident's gross income.1 The program is run by the West Virginia Bureau for Medical Services, part of DoHS.4

The West Virginia Medicaid Personal Needs Allowance vs. the Federal Floor

Federal law sets a floor, not the actual number. Under 42 U.S.C. 1396a(q), the Personal Needs Allowance for an institutionalized person who is aged, blind, or disabled must be at least $30 a month, and at least $60 a month for an institutionalized couple when both spouses are aged, blind, or disabled. The couple figure applies when their incomes are considered available to each other in deciding eligibility. Those figures have stayed the same since 1988, when the Omnibus Budget Reconciliation Act of 1987 first set them.2

States are free to set their own allowance above that floor. West Virginia's $50 sits above the $30 federal minimum.2,1 It is a modest margin, but it is more than the least the state could protect.

Here's the practical takeaway: the $50 figure is a West Virginia policy choice, not a federal cap, and it can change if the state amends its manual. The federal $30 is simply the lowest West Virginia could go. For now, a nursing home resident in West Virginia keeps $50 a month, with one exception that we'll come to below.1

How the Money Is Held: The Resident Trust Fund

The $50 doesn't just appear as cash each month.1 If the resident chooses, the facility can hold it in a resident trust fund, a personal account the nursing home keeps on the resident's behalf.3 Federal nursing-facility rules at 42 CFR 483.10(f)(10) spell out how this has to work, and they're worth knowing because they exist to protect the resident from a facility mishandling their money.

A few rules stand out. A facility cannot require a resident to deposit their personal funds with it. If the resident chooses to, then once the resident authorizes it in writing, the facility has to act as a fiduciary, meaning it manages the money for the resident's benefit and not its own. For a Medicaid resident, any balance above $50 has to sit in an interest-bearing account, separate from the facility's operating accounts.3 The facility has to keep a full, separate accounting with no commingling of resident money and facility money, and it has to make the resident's financial record available through quarterly statements and whenever the resident asks.3

There's a caution buried in this system. The trust fund balance still counts for Medicaid eligibility, and West Virginia's resource limit is $2,000 for one person.4 If the $50 piles up month after month without being spent, the balance can drift toward that limit and put eligibility at risk. Federal rules require the facility to warn a Medicaid resident when the account reaches $200 less than the Supplemental Security Income (SSI) resource limit for one person, and to explain that if the account plus the resident's other countable resources reaches that limit, they may lose Medicaid or SSI.3 The safe habit is to spend the allowance down rather than let it accumulate. Ask the facility for the quarterly statement, check it against what you know was spent, and keep an eye on the running balance.

Where the Allowance Fits in Patient Liability

To see why the $50 matters, it helps to see where it lands in the monthly calculation.1 When West Virginia works out how much of a resident's income goes to the nursing home, it starts with gross income and subtracts a short list of protected amounts. What's left is the patient liability, the check that goes to the facility.

The Personal Needs Allowance is the first deduction. Federal rules list the deductions in this order:2

1. Start with the resident's gross monthly income (Social Security, pension, and so on).
2. Subtract the $50 Personal Needs Allowance the resident keeps.1
3. If there's a spouse still living at home, subtract a maintenance allowance so the at-home spouse has enough to live on (a separate allowance applies when other family members live at home).
4. Subtract medical costs the resident still owes that no one else pays, such as a Medicare or other health insurance premium, deductible, or coinsurance.2
5. What remains is the patient liability, paid to the facility each month.

That third step matters for married couples. When one spouse enters a nursing home and the other stays in the community, West Virginia can shift income to the at-home spouse to bring them up to the Minimum Monthly Maintenance Needs Allowance. That is a floor, not a cap: it starts at $2,705 a month as of July 1, 2026, and high shelter costs can raise it as far as $4,066.50 a month.5 If the at-home spouse shows at a fair hearing that exceptional circumstances are causing significant financial hardship, the allowance can be set higher still.5 The details of that protection are their own topic, and our West Virginia spousal impoverishment guide walks through them. For the PNA, the point is simpler: the $50 comes off the top, before the patient liability is figured, so the resident always keeps it no matter how the rest of the math shakes out.1

What the Facility Must Provide and Can't Charge to the Allowance

A common worry is that the nursing home will nickel-and-dime the $50 down to nothing with charges for everyday items.1 Federal law draws a firm line here. Under 42 CFR 483.10(f)(11), a range of routine items and services are already covered by the facility's daily Medicaid payment, so the facility can't turn around and bill the resident's personal funds for them.

That protected list includes:

• Nursing services
• Food and nutrition services, including special foods or supplements a resident's doctor orders
• The facility's activities program
• Room and bed maintenance
• Routine personal hygiene items and services, such as soap, a toothbrush and toothpaste, a comb and brush, a razor and shaving cream, lotion, incontinence supplies, towels and washcloths, over-the-counter drugs, and basic hair and nail care
• Bathing assistance and basic personal laundry
• Medically related social services
• Hospice care the resident elects, when Medicare or Medicaid pays for it

Because the daily rate already pays for those, none of them may be charged against the resident's Personal Needs Allowance during a covered stay.6 The allowance is meant for the extras, the personal choices beyond the basic level the facility supplies. If someone wants a specific brand of shampoo rather than the facility's, a magazine, a phone line, or an outing beyond the activities program, that can come out of the PNA. The basic version of the same thing does not. Even for extras, the facility can charge only when the resident asked for the item, it isn't needed for the resident's care plan, and the facility said beforehand that there would be a charge.6

If you see charges for items on the protected list showing up against a resident's trust account, that's worth questioning. It can be a sign the facility is billing the resident for care the daily rate already covers, which the rules don't allow.

How the VA Pension Cap Changes the Allowance

There's one situation where the West Virginia allowance changes, and it involves veterans. It's also the spot where families most often get confused, so it's worth taking slowly, one rule at a time.

Start with the federal VA rule. Under 38 U.S.C. 5503(d), when a veteran who has neither a spouse nor a child is covered by Medicaid for nursing-facility care, the VA pension is capped at $90 a month for any period after the month of admission, and the same rule covers a surviving spouse with no child. VA's own regulation instead ties the limit to the month Medicaid payments begin, so if Medicaid approval came months after admission, confirm with VA which month the reduction starts. The law also says the facility's Medicaid payment can't be reduced by that retained $90, which means the $90 stays with the veteran rather than flowing to the nursing home.7

One kind of facility is left out of that rule on purpose. The same subsection defines the nursing facility it covers, at 38 U.S.C. 5503(d)(1)(B), as one described in section 1919 of the Social Security Act other than a State home for which the VA makes per diem payments for nursing home care under 38 U.S.C. 1741(a). A veteran on Medicaid who lives in a State veterans home for which the VA makes those per diem payments is outside the $90 cap, so the cap must not be applied to that stay at all.7 In short, a single, childless veteran on Medicaid nursing-home care in an ordinary nursing facility keeps a $90 VA pension; in a State veterans home the VA pays that per diem for, this cap is not what sets the pension.

Now the West Virginia side. For a resident who is receiving that reduced $90 VA pension, West Virginia sets the Personal Needs Allowance at $90 a month instead of the usual $50.1 That's the state's own rule from its Income Maintenance Manual, and it lines the state allowance up with the reduced pension amount.

These are two separate rules from two separate sources, and it's best to keep them that way rather than trying to add them into a single headline number. The federal rule governs how much VA pension the veteran keeps. The West Virginia rule governs the size of the Medicaid Personal Needs Allowance for that veteran. Note that West Virginia's $90 line is keyed to a resident who is actually receiving the reduced pension, so a veteran the federal cap never reached takes the $50 standard allowance instead.1 The $90 replaces the $50; it is never $50 plus $90.1 If a caseworker or a facility seems unsure how a veteran's numbers work, it's reasonable to ask them to look at each rule on its own terms. Because the VA pension and Medicaid interact in ways that depend on the veteran's exact family situation and the type of benefit, a married veteran or one receiving Aid and Attendance may see a different result, and it's worth confirming with both a Medicaid caseworker and a Veterans Service Officer.

Learn More

Find personalized help understanding the West Virginia 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.