West Virginia Nursing Home Personal Needs Allowance and Patient Liability

When your parent enters a nursing home on Medicaid in West Virginia, nearly all of their monthly income goes directly to the facility. What they're allowed to keep — and what happens when they need to leave temporarily — follows specific state rules that most families learn about only after admission.

The $50 Personal Needs Allowance

Medicaid nursing home residents in West Virginia keep a personal needs allowance (PNA) of $50 per month from their income. This is the money your parent has for any personal expenses not covered by the facility: clothing, toiletries beyond what the facility provides, phone charges, personal subscriptions, haircuts, or small gifts.

Fifty dollars per month is not a lot. It's one of the lower PNAs in the country, and it hasn't kept pace with inflation. Families often supplement this with their own funds — which is perfectly allowed and doesn't affect Medicaid eligibility, as long as the money goes to personal items and doesn't accumulate in savings above $2,000.

How Patient Liability Works

Everything your parent receives monthly — Social Security, pensions, annuities, investment income — minus three specific deductions equals their patient liability. That amount goes to the nursing home each month.

The three deductions:

1. Personal needs allowance: $50
2. Health insurance premiums: Medicare Part B, Medigap supplemental insurance, or other qualifying health insurance premiums are deducted before calculating patient liability
3. Spousal maintenance allowance: If the community spouse's income is below the MMMNA ($2,705 minimum, up to $4,066.50 with excess shelter costs), a transfer from the applicant spouse's income is deducted

For example, if your parent receives $2,400/month in Social Security and pension, pays $185/month for Medicare Part B, and their spouse qualifies for a $500/month income transfer:

• Total income: $2,400
• Minus PNA: −$50
• Minus Medicare Part B: −$185
• Minus spousal allowance: −$500
• Patient liability: $1,665/month to the nursing home

The facility receives $1,665 from your parent plus the Medicaid daily rate from the state. Together, these cover the full cost of care.

The ADW Difference

Under the Aged and Disabled Waiver for home care, the income retention rule is completely different. ADW enrollees keep 100% of their monthly income as their personal needs allowance — because they're still responsible for housing, food, and utilities at home. There is no patient liability payment to a facility.

This is one of the most significant financial differences between nursing home care and the ADW waiver. A parent with $2,400/month in income keeps $50 in a nursing home but keeps the full $2,400 on the waiver.

Bed Hold During Hospital Stays

If your parent on Medicaid needs to be hospitalized, the nursing facility may hold their bed — but the rules around who pays for that hold matter.

West Virginia's Medicaid bed hold policy allows a reserved bed during a temporary absence (hospital stays or therapeutic leave). The facility continues to receive a reduced Medicaid payment during the bed hold period. Your parent's patient liability continues to apply during this time.

If the absence extends beyond the state's allowed bed hold period, the facility can give the bed to another resident. Your parent retains the right to return to the next available bed of their choice (semi-private or private, matching their prior arrangement), but there's no guarantee it will be in the same room.

Families should clarify the facility's specific bed hold policy at admission, including how many days are covered and what happens if the hospitalization extends beyond that window.

Monitoring Your Parent's Funds

Nursing homes are required to maintain an accounting of each resident's personal needs funds if the facility manages the money. You have the right to review this accounting at any time. If the personal needs account balance approaches $2,000, the excess must be spent — otherwise it becomes a countable asset that could jeopardize Medicaid eligibility at the next redetermination.

The West Virginia Medicaid Long-Term Care & Asset Protection Guide includes a patient liability worksheet that calculates the exact monthly amount based on your parent's income, insurance premiums, and spousal allowances.

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