Do I Have Nursing Home Patient Liability?

What does “patient liability” mean for Medicaid nursing home care?

Most beneficiaries must contribute the majority of their monthly income toward nursing home costs — this required payment is the patient liability (also called “share of cost,” “patient pay,” or “co-pay”). Medicaid pays the remainder after allowable deductions.

How is your monthly patient liability determined?

Medicaid totals your gross monthly income and subtracts permitted deductions. If deductions reduce income to zero, there’s no patient liability that month.

Formula: Total monthly income − (Personal Needs Allowance + unreimbursed medical/remedial expenses + Spousal/Family allowances + Home Maintenance Allowance) = patient liability.

Which deductions and allowances can reduce the amount you owe?

What is the Personal Needs Allowance (PNA)?

A small monthly amount the resident may keep for personal items (clothing, haircuts, books, snacks). In 2025, PNAs generally range $30–$200/mo by state. Examples: CA $35, NY $50, TX $75, AZ $145.05, FL $160, AK $200.

VA pension note: Single veterans/surviving spouses on A&A/Housebound often receive a reduced VA pension of $90/mo that is excluded from Medicaid income. Some states allow it in addition to the PNA; others treat it in place of the PNA.

Can uncovered medical or remedial expenses be deducted?

Yes. Deduct premiums, deductibles, co-insurance, dental, eyeglasses, hearing aids, prescribed OTCs/supplements, and certain unpaid nursing home charges incurred pre-approval (state rules vary).

What is the Home Maintenance Allowance?

A temporary (typically up to 6 months) deduction for rent/mortgage, utilities, taxes, and insurance if there’s documented intent to return home (physician statement usually required). 2025 examples: AZ $210, CA $209, PA $989.10, WA $1,304. Some states use a fixed cap; others use actual costs up to a ceiling. (Minnesota generally limits to 3 months.)

How does the Spousal Income Allowance (MMNA) work?

To prevent spousal impoverishment, the community spouse may receive a monthly income transfer from the institutionalized spouse. In 2025, state rules set the amount between $2,643.75 (minimum, effective 7/1/25) and $3,948 (maximum, effective 1/1/25). Some states use one fixed “standard” figure; others calculate within min/max and may increase for verified shelter/utility costs.

Is there an allowance for dependent family members?

Yes. States offer formula-based allowances for eligible dependents (e.g., minor or adult children, certain parents/siblings). Amounts and formulas vary and can be additive to the spousal allowance when applicable.

Do HCBS Waiver recipients also have a patient liability?

Often yes. Some Waiver programs assess a monthly share of cost using a similar deduction framework.

Patient liability examples (2025)

Single resident

Eleanor (OR): Income $2,000; PNA $77.14; Medicare premium $185 → Patient liability = $1,737.86.

Married resident with spousal allowance

William (CO): Income $2,200; PNA $108.73; Spousal allowance $1,948 → Patient liability = $143.27.

State-by-State Reference (2025)

What’s my state’s Personal Needs Allowance (PNA)?

PNAs are set by each state and can change. Below are confirmed figures where available and directional notes elsewhere. Verify locally before publishing.

What’s my state’s Spousal Income Allowance (MMNA) rule?

Most states use federal min/max: $2,643.75 (min; 7/1/25–6/30/26) and $3,948 (max; 1/1/25–12/31/25). Some states adopt one fixed “standard” figure.

Tip: In range states, a community spouse is automatically brought up to the minimum. If verified shelter + SUA exceed the baseline, the allowance may rise up to the maximum ($3,948).

Which states publish a Home Maintenance Allowance (HMA)?

Where offered, HMA is typically available for up to 6 months with physician-verified intent to return home. Amounts and names vary.

Editorial note: PNA and HMA figures above reflect commonly cited 2025 amounts where available; some states adjust mid-year. Always confirm with the state Medicaid agency before publication.