When someone needs long-term care in a nursing home, figuring out how much they have to pay — and how much help their spouse can get — can be really confusing. But don’t worry! We’re going to break it all down in a way that’s super easy to understand.

And if you want to skip the math, you can use our MassHealth PPA & Spousal Allowance Calculator to do it for you!

What is the Patient Paid Amount (PPA)?

Let’s say John is moving into a nursing home and he’s approved for help from MassHealth (Massachusetts' Medicaid program). Even though MassHealth will pay most of the cost, John still has to pay part of his monthly income toward his care. That payment is called the Patient Paid Amount, or PPA.

But MassHealth doesn’t take all of John’s money. He gets to keep some for himself. That’s called the Personal Needs Allowance (PNA), and it’s $72.80/month — money for things like snacks, clothes, or toiletries.

What Else Can Be Deducted?

Before the state figures out John’s PPA, they also subtract other approved monthly costs from his income:

• Health Insurance Premiums: If John pays for Medicare Part B or other plans like Medex or AARP, those monthly costs are fully deducted from his income before the PPA is calculated.
• Disabled or Blind Child: If John has a blind or permanently disabled child (no matter their age) living in the community, it may result in a $0 PPA. MassHealth’s LTSS office calculates this automatically.

These extra deductions can lower — or even eliminate — how much John needs to pay toward his nursing home care each month.

How is PPA Calculated?

Start with Gross Monthly Income: This includes sources like Social Security, pensions, or other income.

Subtract Allowable Deductions:

• Personal Needs Allowance (PNA): A fixed amount ($72.80 as of 2025) that the resident keeps for personal expenses like toiletries or clothing.
• Health Insurance Premiums: Any monthly premiums paid for health insurance, such as Medicare Part B.

Resulting Amount: The remainder is the PPA, which goes toward the cost of nursing home care.

Example:

• Johns Monthly Income: $1,500
• PNA: $72.80
• Health Insurance Premium: $185

PPA Calculation: $1,500 - $72.80 - $185 = $1,242.20

So, John would pay $1,242.20 monthly toward their nursing home care.

What If John Is Married?

Let’s say John is married to Rose. Rose does not need long-term care in a nursing home so she will remain at couples’ home in the community.

MassHealth wants to make sure Rose has enough money to pay for rent, food, and bills — so they let her keep part of John’s income. This is called the Spousal Allowance or Monthly Maintenance Needs Allowance (MMNA).

Here’s what you need to know:

• Minimum MMMNA: $2,555 per month (as of 2025).
• Maximum MMMNA: $3,948 per month (as of 2025).

If Rose earns less than the MMMNA of $2,555 on her own, MassHealth allows her to take a portion of John’s income until she reaches that amount.

What About Housing and Utilities?

MassHealth understands that housing and utility expenses can be a financial burden for the spouse who remains at home. To help cover these essential living costs—like rent, mortgage, property taxes, and home owners insurance—they’ve created a rule known as the Monthly Housing Allowance, also called the Excess Shelter Allowance.

In Massachusetts, this allowance is $766.50 per month.

If Rose’s total housing expenses exceed $766.50/month, she can keep more of John's income to help pay the bills.

Standard Utility Allowance (SUA)

If Rose also pays for utilities, she may qualify for an additional allowance. The SUA is a set amount that gets added to her shelter costs, potentially increasing how much income she’s allowed to keep. It covers typical utility expenses like: Heating or air conditioning, Electricity, Water, Sewer, Garbage removal, Basic phone service.

Massachusetts SUA Breakdown:

• Pays for utilities including heating/AC: $890
• Pays for utilities excluding heating/AC: $542
• Pays no utilities: $0

Together, these allowances help ensure the spouse at home isn’t left struggling to meet basic living expenses.

Real-Life Example

Let’s say:

• John makes $3,000/month
• Rose makes $500/month
• They pay $600/month for mortgage + taxes, and $100 for home owners insurance = $700 total housing cost
• They also pay for heating and cooling, so they qualify for a $890 SUA

Step-by-step:

• John keeps $72.80 for his PNA
• Rose needs $2,055 from John to reach the $2,555 MMNA
• That leaves John with: $3,000 - $72.80 - $2,055 = $872.20
• Rose’s total shelter costs = $700 + $890 = $1,590
• Subtract $766.50 from $1,590 = $823.50 in extra shelter allowance
• Since John still has $872.20, he can give Rose the full $823.50
• Rose gets:$500 (her income) + $2,055 + $823.50 = $3,378.50/month
• John’s remaining income:$3,000 - $72.80 - $2,055 - $823.50 = $48.70
• So, John’s PPA = $48.70/month

Don’t Want to Do the Math?

Use our free MassHealth PPA & Spousal Allowance Calculator to easily estimate:

• How much the nursing home resident pays (PPA)
• How much the at-home spouse gets to keep

Bonus Tip:

If your situation is complicated — like really high bills or medical needs — you can ask for a Medicaid fair hearing (appeal) to try and get more financial help.

Final Thoughts

MassHealth rules can be a lot to figure out. But with the right information (and a little help from our calculator), you can plan wisely and protect your family's financial future.

Click here to try the calculator

Need more help? Reach out to a Medicaid expert or elder law attorney