Patient Paid Amount (PPA):
In Massachusetts, nursing home residents who qualify for MassHealth Long-Term Care coverage must pay most of their monthly income toward the cost of their care. This required monthly contribution is called the Patient Paid Amount (PPA). Instead of having a strict income limit, Massachusetts uses a spend-down approach, allowing applicants to qualify even if their income exceeds certain thresholds.
Personal Needs Allowance (PNA):
The Personal Needs Allowance (PNA) is the designated portion of monthly income that a person in long-term care is allowed to retain for personal expenses. As of now, this amount is fixed at $72.80 per month.
What is the Monthly Maintenance Needs Allowance (MMNA)?
Let’s say a married couple is dealing with a tough situation—one spouse has to move into a nursing home, and the other stays at home. Medicaid helps pay for the nursing home, but it also has rules to make sure the spouse who stays at home isn’t left without enough money to live on.
That’s where the Monthly Maintenance Needs Allowance (MMNA) comes in. It’s the minimum amount of income the spouse at home is allowed to have each month to pay for things like food, rent, and utilities.
If the spouse at home doesn’t make enough money on their own, the spouse in the nursing home can give them part of their income—so they both stay financially stable.
- In Massachusetts, the minimum MMNA is $2,555 per month.
- If living expenses are high enough, the allowance can go up to a maximum of $3,948 per month. That’s called the Maximum Monthly Maintenance Needs Allowance.
What is the Monthly Housing Allowance (Excess Shelter Allowance)?
If one spouse is living in a nursing home and the other is still living at home, Medicaid has rules to make sure the spouse at home can still afford basic living costs—like rent or a mortgage. One of those rules is called the Monthly Housing Allowance, or sometimes the Excess Shelter Allowance.
This allowance helps the spouse at home (called the community spouse) keep more money from their partner's income if their housing costs—like rent, mortgage, property taxes, or home insurance—are really high.
- In Massachusetts, the Excess Shelter Allowance is $766.50 per month.
- If the community spouse’s housing costs are higher than that, they may be allowed to keep more income from their spouse to help cover those bills.
For example:
If their housing costs are $150 more than the allowed amount, they can get an extra $150 each month.
But there’s a limit:
No matter how high their housing costs are, the maximum amount they can receive each month is $3,948 (called the Maximum Monthly Maintenance Needs Allowance).
Standard Utility Allowance
A Standard Utility Allowance (SUA) can be added to one’s shelter costs, which can further increase one’s Spousal Income Allowance. The SUA is an average monthly utility cost. Utilities that are considered may include cooling/heating, electricity, basic phone service, sewage, garbage, and water
Standard Utility Allowance (SUA) for Massachusetts
- For community spouses that pay for utilities including heating and or air conditioning the SUA is $890
- For community spouses that pay for utilities NOT including heating or air conditioning the SUA is $542
- For community spouses that do NOT pay for utilities the SUA is $0
What if the Monthly Maintenance Needs Allowance (MMMNA) Still Isn’t Enough?
Sometimes, even with help from Medicaid, the spouse living at home still doesn’t have enough money to cover their bills. If that happens, they might be able to ask for more money by requesting a Medicaid fair hearing—which is basically an appeal.
This hearing lets you challenge the decision Medicaid made and explain why you need more help.
To get the MMMNA increased, you have to show that you’re facing special financial problems (called exceptional circumstances)—like:
- A big medical bill
- Old credit card debt from before your spouse needed care
- Helping pay for a close family member, like a brother or sister
These are situations where you don’t have enough money to cover those extra costs and your regular living expenses. That’s called financial duress.
Everyone has the right to a fair hearing, and Medicaid has to tell you how to request one. Usually, you have 30 to 90 days to make the request after Medicaid makes a decision.If you’re not sure how it works in your state, you can contact your state’s Medicaid office for help.
