Long-term services and supports Personal Needs Allowance (PNA) chart
Purpose: Use the PNA for the individual's circumstances based on the chart below.
- 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.
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 HCS individuals on Waiver services admitting to a facility get the higher HCS Waiver PNA when admitting from a home setting to a facility in a month. (FPL).
- 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.
When do PNA standards change?
- See effective on the Medicaid standard chart when PNA amounts are based on the Standards - LTSS. Links to the WAC are highlighted.
- PNA amounts in a medical institution or ALF for SSI related change periodically due to legislature budget funding.
- Effective 1/1/2019 PNA amounts for individuals receiving MPC or Waiver services from HCS or DDA in an ALF will be $70.00.
What is the ALTSA 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. ADSA individuals have a room and board standard. The formula for the room and board standard is indicated in the standard chart below.
- Individuals receiving Medicaid Personal Care under the Determining eligibility for noninstitutional coverage in an Alternate Living Facility (G03 or L52 group C and D) pay a higher amount to the provider than the room and board standard. See Medicaid Personal Care and Determining eligibility for noninstitutional coverage in an Alternate Living Facility (G03 or L52 group C and D) sections for further instructions.
Personal Needs Allowance and ALTSA Room and Board
|Medical institutions WAC 182-513-1380||PNA amount|
|Medical institutions (nursing home, hospice care center, RHC) out of home full month Effective 1/1/2019 and ongoing||$70.00|
|State Veterans Home||$160.00|
|Admit from home to NF or discharge to home from NF during the month no Waiver services (MNIL)||
|ABD state cash assistance and MCS payment standard in a medical institution.||$41.62|
|Home and Community Service Waivers Chapter 182-515|
|Home setting. Single person (COPES, New Freedom, PACE, RCL) FPL changes annually on April 1. Married person on CN Waiver living at home and apart from the community spouse. See note in WAC 182-515-1509||
|Home setting. Married with a community spouse. (COPES, New Freedom, PACE, RCL) MNIL changes annually on January 1||
|Medical institutions WAC 182-513-1380|
|ALF/residential settings (COPES, New Freedom, PACE, MNRW, RCL). Effective 1/1/2019 and ongoing||$70.00|
|Maintenance in an ALF /residential settings. From this amount an individual keeps $70.00 PNA and pays the remainder to the ALF as room and board. FBR changes annually on January 1.||
Aging and Long-Term Support Administration (ALTSA) Room and Board Standard
|ALTSA room and board standard is based on the FBR rate minus the current HCB Waiver in ALF PNA. Room and board is considered the non personal care cost of the ALF (meals and shelter). This standard is used for DDA and HCS services authorized in an ALF with the exception of MPC under the Determining eligibility for noninstitutional coverage in an Alternate Living Facility (G03 or L52 group C and D). It is the maximum amount paid for room and board in a contracted/licensed ALF.||
|Developmental Disabilities Administration (DDA) Waivers WAC 182-515-1510|
|DDA waiver at home (SIL) 300% of the FBR||
DDA waiver in ALF
|Medicaid Personal Care (MPC)|
|Home setting. No cost to individual, No PNA for MPC at home|
Hospice services outside a medical institution
|If using HCS CN (COPES) Waiver rules for eligibility use the same PNA as you would for the HCS CN Waiver program. If the individual is on Hospice index and Waiver services at the same time, the Waiver program is the priority program.|
State Funded ABD cash and MCS medical standards
|Living in a medical institution ABD cash/MCS medical standard.||$41.62|
|ABD cash: Living in an adult family home (AFH) An adult family home is considered a non facility setting. Individuals are allowed to keep a PNA of $38.84 from the payment standard. The remainder goes to the AFH for room and board.||
$339.00 until 12/31/2010
$266.00 1/1/2011 to 3/31/2011
|ABD cash/MCS medical standard: Living in a boarding home (assisted living, ARC, EARC, DDD group home) receive a PNA check for $38.84. WAC 388-478-0006||$38.84|
|MCS Medical Standard at home supplied shelter WAC 388-478-0090||$206.00|
|MCS Medical Standard at home or AFH renting WAC 388-478-0090||$339.00|
SSI Individual living in a Medical Institution
|SSI individuals living in a medical institution receiving $30 federal PNA will receive a state supplement to bring their PNA amount up to the $70.00 PNA standard. Effective 1/1/2019||$70.00|