Residents of long-term-care facilities rarely need cash. Room and board, housekeeping and activities are all included in the monthly cost of a nursing home. But what’s a resident to do when she runs out of her favorite perfume, or when he wants to give a birthday gift to a grandchild? If MassHealth is covering the cost of the resident’s long-term care, these extras have to come out of his or her personal needs allowance, or PNA.
MassHealth and the Personal Needs Allowance
As anyone who’s started the MassHealth application process for long-term care knows all too well, the financial requirements for eligibility are very strict. Residency in a nursing home costs thousands of dollars per month. MassHealth will only cover the costs for residents who don’t have the means to pay for that care themselves. That’s why the program uses a five-year lookback period. Applicants can’t simply give money away at the last minute to qualify for coverage – their financial records have to prove that they need it.
The financial oversight doesn’t end when coverage begins. MassHealth requires recipients of long-term-care coverage to contribute to the costs of their own care, if their monthly income is substantial enough. The portion of the monthly bill that the resident pays is called the patient-paid amount, or PPA. Covered individuals may only keep a small amount of money each month, with the rest of their monthly income going to help pay for their care and/or the care of their spouse, home or family. The amount that a nursing-home resident is allowed to keep is called the personal needs allowance, or PNA.
The PNA amount for MassHealth is $72.80 per month, as of 2019. It has remained unchanged for several years.
How PNAs Work
A nursing-home resident can use his or her PNA to pay for any personal items that aren’t provided by the home. Residents may use these funds to pay for clothing, hairstyling services, beauty and grooming products, reading material, small gifts, outings with family members and other incidentals.
A covered individual can manage how the PNA balance is spent, but it’s not up to the individual to move $72.80 into the account each month. Instead, MassHealth deducts it from the resident’s monthly income. The monthly PNA amount is the first deduction taken from a resident’s income each month, so even a member who only receives a monthly income of $100 can fund his or her own PNA. MassHealth will also fund the PNA of a member who doesn’t have any income.
If you’re a married MassHealth applicant whose spouse relies on your income, you also need to know about the minimum monthly maintenance needs allowance, or MMMNA. MassHealth recognizes that the community spouse – the one who isn’t applying for long-term-care coverage – needs to keep a source of income. MassHealth uses a formula that takes into account the community spouse’s housing costs to determine the MMMNA, which must fall between a set minimum and maximum amount. For 2019, the MMMNA minimum is $2,057.50 and the maximum is $3,160.50. If the community spouse doesn’t have enough income to reach the minimum MMMNA, some of the MassHealth member’s monthly income can be used for this purpose. The MMMNA is the second deduction made from a member’s income each month, after the PNA.
Creating a Personal Needs Allowance Account
Long-term-care facilities commonly maintain PNA accounts for their residents. This system makes it easy for residents to access their money and keep track of their PNA balances. Facilities that manage their residents’ PNA accounts must comply with a number of requirements, per 130 CMR 456.00. Care facilities are not allowed to deduct money from their residents’ PNAs to pay themselves for services. They are not allowed to charge residents for any service charges related to managing PNA accounts. Facilities also have strict accounting and reporting requirements for PNA funds, and must repay residents for any PNA funds that are lost or stolen.
The money kept in your PNA account need not be spent by the end of each month. Money can roll over from month to month without issue, as long as the total in the account doesn’t take you over the MassHealth asset limit of $2,000.
If you apply for and are approved for long-term-care coverage under MassHealth, establishing a PNA account is easy. A facility must manage the PNA accounts of its MassHealth-covered residents, if the residents request this service. However, MassHealth members can’t be required to keep their PNA accounts at their long-term-care facilities. Covered individuals may keep their PNA accounts independent from the facilities where they reside.
Planning for a PNA account is just one of the many pieces of the MassHealth application puzzle. If you have questions about PNAs or any part of the MassHealth application process, contact the Ladimer Law Office.
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