Important: Stay covered! Are you enrolled in Apple Health (Medicaid) coverage? Make sure your address and phone number are up to date so you can stay enrolled. Report a change.
Long-term services and supports Personal Needs Allowance (PNA)
Purpose: Use the Personal Needs Allowance (PNA) for the individual's circumstances.
The current PNA standards can be found on the Program standard for income and resources page. The most current Apple Health Income and Resource standard chart is at the top of the page and past charts are listed below with their effective date.
- The PNA is based on living arrangement/setting and service throughout the month.
- If the individual has lived in multiple settings or been on multiple services, choose the highest PNA available based on all the settings or services for the month, including the short-stay setting.
- An individual going from ALF to NF in one month and back to an ALF the following month is allowed to keep the PNA for an ALF setting.
- An individual going from HCS or DDA Waiver in home to NF on the 1st day of the month is allowed the full Waiver PNA based on the service authorized because they were in a home setting at least one moment in the month.
- An individual converting private pay to NF is allowed the NF PNA.
- An individual converting private pay ALF to Waiver ALF on the 1st day of the month is allowed the ALF PNA.
- An individual converting private pay ALF to Waiver (COPES) ALF any day of the month other than the first day is allowed the full MNIL as we cannot backdate Waiver (COPES) in that month.
Private pay nursing home case to Medicaid:
- The PNA for private pay NF to medicaid is the medical institution PNA. We do not allow the MNIL for private pay to Medicaid in the month of conversion unless the individual was residing outside a medical institution at any time during that month. If the individual was in a medical institution the entire month, use the medical institution PNA in the conversion month. Indicate the original date of admission into the facility as the NF admit date, and the date Medicaid payment is authorized to start as the authorization date.
When to use the MNIL as the PNA:
- When an individual admits or discharges home at any time during a month, their PNA is at least the MNIL, regardless of marital status.
- If an individual is eligible for a PNA that is higher than the MNIL, use the higher PNA.
- Single individuals on HCBS Waiver services admitting to a facility get the higher HCBS Waiver PNA when admitting from a home setting to a facility in a month.
- Private pay ALF individuals converting to medicaid on the first day of the month get the ALF PNA.
- (Waiver eligibility starts on the first day of the month)
- Private pay ALF individuals converting to medicaid after the first day of the month get the MNIL.
- (Waiver eligibility starts on a day after the first of the month)
- This allows a case not converted on the first day of the month due to the inability to backdate waiver eligibility the full benefit of the MNIL.
What is the room and board standard?
- Individuals living in alternate living facilities (ALF) such as adult family homes, assisted living facilities and DDA group homes must pay room and board to the facility from their income for their food and shelter per WAC 182-513-1105.
- Individuals receiving services from DDA, HCS, or Behavioral health under WAC 182-513-1205 may pay a higher amount to the provider than the room and board standard.