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The personal needs allowance in a nursing home

When the person you're payee for lives in a nursing home, a group home or another facility, part of their benefits each month is set aside for them alone. Here's where the figure comes from, what it can buy, and what it can't.

A pair of black open-toe house slippers with thin white stripes and woven straw insoles, side by side on a dark floor.
Photo by Hitomi Bremmer on Unsplash

When the person you're payee for lives in a facility, SSA expects you to set aside at least $30 of their benefits each month for their own personal needs. That money is called the personal needs allowance. SSA's policy says it can't be used for the facility's charges or for any past-due bill owed to the facility.

SSA applies this to residents of any kind of facility, including hospitals, nursing homes and group homes, whether or not Medicaid helps pay for their care.

Where the $30 comes from

For someone on SSI, the figure is written into SSI itself. When they're in a medical treatment facility for a full month and Medicaid pays more than half the cost of their care, the SSI rate drops to $30 a month, or $60 for a couple who are both in a facility. Any other countable income is subtracted from that rate, as usual, so the payment can be less. SSA's policy says that reduced payment must be used only as the person's personal needs allowance.

Medicaid has its own rule that points the same way. When a state's Medicaid program works out how much of a resident's income goes toward their care, it must first protect a personal needs allowance of at least $30 a month for an aged, blind or disabled person. That's a minimum, and a state may set it higher. Ask the facility's business office or your state's Medicaid agency which amount applies to the person you're payee for.

What goes to the facility, and what doesn't

The facility's share comes out of the rest of the benefits. SSA asks payees to pay a reasonable share of the facility's customary charges, and not more than the maximum your state's law sets. SSA groups those charges with things that improve the person's condition or help them leave the facility, and calls all of it current maintenance.

Don't use the benefits to buy something the facility normally provides, or something a state or federal program covers. If that happens, SSA asks you to apply to the program that normally pays, put the money back into the person's account when it arrives, and show SSA that you did.

When the person leaves the facility, you can pay its charges for the last month they lived there. Benefits for the months after that can't be used to catch up on unpaid charges from the stay.

What the allowance is for

SSA asks payees to use good judgment, and to choose things that help the person keep contact with "the outside world" and keep their sense of individuality. Its examples include:

  • clothing, such as seasonal clothes, shoes and slippers
  • a phone, a clock, a television or a music player
  • haircuts, toiletries and grooming items
  • art supplies, games and photo albums
  • a quilt, a recliner, or pictures for the wall
  • magazine subscriptions, restaurant meals, and reasonably priced holiday presents for family or friends
  • travel to visit family

Small amounts of spending money count too. SSA suggests handing it over in a way that has no fees, such as cash or a prepaid card.

The allowance can build up over several months for a bigger purchase. Set aside $30 a month for four months, and there's $120 toward a winter coat. If the person can't shop for themselves or tell you what they need, SSA says the facility's staff should look at what would help and recommend it.

If the stay is expected to be short

SSI can sometimes continue at the full rate for up to three full months in a facility, so the person can keep their home to come back to. All of these have to be true: they were getting SSI the month before the first full month in the facility, a doctor certifies in writing that the stay is not likely to last more than 90 full days, and they need the money to keep up the home or living arrangement they'll return to.

The doctor's statement and the evidence about the home both have to reach SSA by the day of discharge or the 90th full day of the stay, whichever comes first. During those months, the benefits can't go to the facility, apart from small amounts to repay it for personal items it bought for the person.

Keeping track of it

For someone on SSI, SSA says not to hold the person's savings to a lower ceiling than the SSI resource limit, so they can make a larger purchase or have money ready if they move out. It also asks payees to keep an eye on high balances so the savings never go over the limit. For someone on Social Security who is covered by Medicaid, SSA asks payees to watch the savings against Medicaid's own resource limit.

Keep the receipts as you would for any other spending. They show the allowance went to the person, and they're part of the records SSA can ask to see.

In PayeeKit, turning on Lives in a facility, under Care setting in the person's details, adds a personal needs allowance account beside the benefits account, so what you spend from it is recorded on its own. For someone on SSI, its balance counts in the resource watch. PayeeKit never suggests an amount: you enter the one your state and facility set.

Sources

PayeeKit is an iPhone ledger for family representative payees and guardians. See how it works.

This post is general information, not advice about anyone's situation. SSA and your state decide what applies to the person you're payee for, and your notices and their own pages are the final word.