Patient Liability and Personal Needs Allowance for Georgia Medicaid Nursing Home Residents

What Patient Liability Means

When a Georgia nursing home resident qualifies for Medicaid, Medicaid does not pay the full cost of care. The resident must contribute most of their monthly income toward the nursing home bill. This contribution is called "patient liability" — and calculating it correctly is one of the most error-prone steps in the entire Medicaid process.

The formula is deceptively simple: take the resident's total gross monthly income, subtract the allowed deductions, and the remainder goes to the nursing home.

The Deductions

Personal Needs Allowance (PNA): $70 per month. Georgia sets this amount by state policy (PAMMS Appendix A1, Chart A1.9). This is the only money the Medicaid nursing home resident keeps for personal expenses — toiletries, clothing, phone charges, haircuts, or anything else not provided by the facility. The allowance applies uniformly statewide and does not vary by county or facility type.

Seventy dollars per month to cover every personal need is brutally low, and families are often shocked when they learn this number. The facility cannot take this money. It belongs to the resident, and the nursing home is required to maintain a personal funds account for residents who request one.

Health insurance premiums. Medicare Part B premiums ($202.90 per month for most beneficiaries in 2026) and any supplemental insurance premiums are deducted before calculating patient liability. If the resident pays for a Medigap policy that was in place before the nursing home admission, those premiums continue to be deductible — though many families find it worthwhile to drop Medigap coverage once Medicaid is paying for nursing home care, since Medicaid covers virtually everything Medicare does not.

Community Spouse Monthly Income Allowance. If the resident's spouse lives at home and their personal income falls below the Minimum Monthly Maintenance Needs Allowance (MMMNA floor of $2,705 in 2026), the difference can be diverted from the resident's income to the spouse. This deduction comes out before patient liability is calculated.

Qualified Income Trust (QIT) pass-through. If the resident has a Miller Trust, the mechanics of the trust interact with patient liability. Income flows into the personal bank account, the trustee transfers the excess into the QIT, and the QIT then pays out the personal needs allowance, health insurance premiums, spousal allowance, and the remaining patient liability to the facility. The trust zeroes out each month.

A Worked Example

A Georgia nursing home resident receives $2,400 per month in Social Security and a small pension.

Medicaid pays the remaining amount of the facility's approved rate after the $2,127.10 patient liability. The resident's total income is accounted for — $70 for personal needs, $202.90 for Medicare, and $2,127.10 to the facility.

Common Errors and Disputes

Facility billing above the patient liability amount. Once Medicaid is approved, the nursing home cannot bill the resident or the family for amounts above the calculated patient liability. If the facility sends a bill for $3,000 when the patient liability is $2,127.10, the excess charge is improper. Contact the Georgia Long-Term Care Ombudsman if this occurs.

Failure to account for income fluctuations. Social Security cost-of-living adjustments (COLA) change the income figure every January. When income increases, patient liability increases by the same amount (minus any concurrent increase in the PNA or Medicare premium). Families should review the patient liability calculation annually and report changes to DFCS.

Facility demanding a "bed hold" payment during hospitalization. When a Medicaid nursing home resident is temporarily hospitalized, ask the facility and DFCS which bed-hold rules and charges apply. Keep any payment terms in writing, and do not assume a private-pay bed-hold surcharge is required without confirming its basis.

Missing the personal needs allowance. Some families do not realize the $70 PNA exists and allow the facility to sweep the resident's entire income. The PNA is the resident's legal right. If the facility is not maintaining a personal funds account and making the $70 available each month, file a complaint with the Healthcare Facility Regulation Division of the Department of Community Health.

During the Medicaid-Pending Period

Before Medicaid is approved — during the 45-to-90-day application processing period — the resident is technically not yet a Medicaid recipient. During this Medicaid-pending phase, the resident pays their estimated patient liability (calculated the same way: income minus PNA and deductions) to the nursing home. The resident does not owe the full private-pay rate during the pending period, provided the Medicaid application is filed and the family is cooperating with documentation requests.

If Medicaid is approved retroactively, ask the nursing home to reconcile payments against the approved coverage and patient liability. Families should track every payment made during the pending period and compare against the final patient liability calculation.

The Georgia Hospital-to-Home Transition Guide includes the QIT transaction tracker that maps every monthly income flow — from Social Security deposit to personal needs allowance to patient liability payment — ensuring the nursing home receives exactly what it's owed and the resident retains the full $70 personal needs allowance.

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