The Nursing Home Takes $2,340 Of His $2,400 Monthly Check. Medicaid Lets Him Keep $60. In Alaska, He’d Get $200

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Picture a widower in a South Carolina care facility. Between Social Security and a small pension, he collects $2,400 a month. Every month, Medicaid’s math directs $2,340 of it straight to the facility. He keeps $60.

That $60 is South Carolina’s personal needs allowance (PNA). It’s the piece of income Medicaid lets an institutionalized resident hold back for personal spending. Everything else runs through a federal formula called post-eligibility treatment of income. That formula sets his “patient liability,” the monthly share he owes the facility, with Medicaid covering the rest.

Move him to Alaska and his allowance jumps to $200. South Carolina and Alaska sit far apart geographically and near opposite ends of the allowance range. Alaska tops out at $200 a month. It shows how one federal program can feel completely different from state to state.

How a $2,400 Check Shrinks to $60 in Pocket Money

Families sometimes mix up Medicare and Medicaid, and the confusion gets expensive. Medicare is the federal health plan for people 65 and older. Part A covers up to 100 days of skilled nursing care per benefit period, and residents pay $217 a day in 2026 for days 21 through 100. Medicare doesn’t cover custodial care if it’s the only care you need. Long stays end up with Medicaid, which is the federal-state program for people with limited income and assets.

Once he qualifies, Medicaid requires nearly all his income to go toward his care. His $2,400 comes in under South Carolina’s 2026 income cap of $2,982 a month, so income alone doesn’t block his eligibility.

His share just dents the bill. The CareScout 2025 Cost of Care Survey puts a semi-private nursing home room in South Carolina at $108,405 a year. That works out to about $9,033.75 a month. He pays his $2,340, and Medicaid covers the rest at its own payment rate.

Why South Carolina Pays $60 and Alaska Pays $200

Federal law sets the floor at $30 a month for an individual, a figure frozen since 1988. States can go higher. In 2026, allowances range from $30 in Alabama to $200 in Alaska.

South Carolina sat at the federal floor for years, then raised its allowance from $30 to $60 effective October 1, 2025. Several states have also made changes. Ohio went from $50 to $75 starting January 1, 2026, and North Carolina went from $30 to $70 in October 2023.

Over a year, the South Carolina resident keeps $720. The Alaska resident keeps $2,400, which is a full month’s check in this example. That $140 monthly gap adds up to $1,680 a year for haircuts, phone bills, and birthday cards for the grandkids.

Part of the gap goes to higher prices up north. The federal government’s regional price index puts Alaska at 102.359 and South Carolina at 93.749, where 100 is the national average.

The allowance pays for what the facility’s daily rate leaves out: clothing, a phone, snacks, magazines, replacement glasses. Federal rules bar nursing homes from charging the PNA for room, board, nursing care, or the basic hygiene items they’re required to provide. The PNA Modernization Act (H.R. 5685) would double the federal floor to $60. As of October 2026, it remains in the House Energy and Commerce Committee.

What Comes Out Before the Nursing Home Gets Paid

The personal needs allowance is the first deduction, but there can be others before patient liability is set, and they can reduce the facility’s cut well:

• Health insurance premiums the resident still pays himself, such as a supplemental policy.
• Medical expenses Medicaid doesn’t cover, which the state lets him deduct from his income.
• A spousal allowance if a wife or husband still lives at home. Medicaid’s spousal impoverishment rules  guidelines can let him direct part of his income to her so she doesn’t fall below a minimum income.
• let him directs part of his income to her so she doesn’t fall below a minimum income. In 2026 that support tops out at $4,066.50 a month.

Medicaid.gov lists these deductions in the federal framework, but each state sets its own details. A married resident whose wife has little income of her own could end up sending much less than $2,340 to the facility.

A Raise That Mostly Goes to the Nursing Home

The 2027 Social Security cost-of-living adjustment (COLA) remains unofficial, with current estimates around 3.5% to 3.6%. The final number is due October 14. For a nursing home resident on Medicaid, a bigger check usually just means a bigger patient liability, and his South Carolina allowance remains at $60 unless lawmakers raise it.

So Medicaid pays a monthly care bill worth thousands of dollars, and he still ends up with very little cash of his own. In South Carolina, that’s $60. In Alaska, it’s $200.

The post The Nursing Home Takes $2,340 of His $2,400 Monthly Check. Medicaid Lets Him Keep $60. In Alaska, He’d Get $200 appeared first on 24/7 Wall St..