(Illustration via Pixabay by geralt)

NURSING AND REST HOME residents on Medicaid give up nearly all their income to support the costs of their care. The pittance that they get to keep each month, known as the personal needs allowance, or PNA, is meant to cover expenses that Medicaid does not, like clothes, shoes, and cell phone bills.  

Massachusetts ranks in the top five states for highest cost of living, yet the PNA here hasn’t changed since 2007, leaving nursing and rest home residents less than $2.50 a day to cover their remaining needs. This barely covers a Dunkin coffee, let alone a typical cell phone bill. 

The PNA varies from state to state and the federal floor of $30 a month hasn’t changed since 1988. Accounting for inflation, the $30 floor would need to be about $80 now to have the same purchasing power. But in Massachusetts, the PNA is only $72.80 a month, so nursing home residents are getting less in value than those at the federal floor were in 1988.  

Three bills introduced this legislation session – H1411, sponsored by Rep. Thomas Stanley of Waltham, S887, sponsored by Sen. Joan Lovely of Salem, and S482, filed by Sens. Patricia Jehlen of Somerville and Mark Montigny of New Bedford — propose to increase the PNA from $72.80 to $113.42, a more than 55 percent increase, and build in an annual cost-of-living adjustment. 

Increasing the PNA lets nursing and rest home residents keep more of their own money, like a mini tax cut for our most vulnerable seniors. Personal expenses, like clothing and cell phone bills, are essential to residents’ quality of life and keeping in touch with family, but the PNA is often insufficient to cover them. 

As one resident in a nursing home shared, “I have to balance… I have to choose between buying my supplements or buying new underwear. I have to choose between going on a fun outing and getting a haircut.” 

Meanwhile, some states, like Alaska, have a PNA of $200 a month, the maximum allowed under federal law currently. So you might be wondering why Massachusetts hasn’t already raised its PNA? 

There hasn’t been organized opposition to raising the PNA; it just hasn’t gotten the attention it deserves. A lack of awareness about issues related to aging and nursing homes are the likely culprit. Sadly, residents are often isolated in nursing homes and largely forgotten. You may not even know the PNA exists unless a loved one is in a nursing or rest home.  

Dignity Alliance Massachusetts, a nonprofit focused on advocacy for older adults and those with disabilities, has made raising the PNA their top legislative priority for 2025, working with the sponsors to introduce these bills this year. They formed in 2020 in response to the severe impact of COVID-19 in nursing homes and count many former legislators, agency officials, and nonprofit leaders in aging and nursing home care among their leadership. 

There are about 33,000 nursing home residents in Massachusetts and about two-thirds of them are on Medicaid. The budget for MassHealth, the state’s Medicaid program, is projected to be $20 billion this year, with the cost split about half each between the state and federal government. Raising the PNA by $40 a month would only increase that amount by a tiny fraction, approximately $10 to $12 million, or less than a tenth of a percent. In return, seniors in nursing homes would get a much-needed raise and better quality of life.  

This is only a cost to MassHealth in the sense that it is allowing seniors to keep more of their own income, still surrendering the vast majority of it to the state in exchange for their long-term care. It could also potentially pay for itself by improving health of nursing home residents, reducing falls, malnutrition, and other health problems that strain nursing home staff and cost Medicaid considerably more in emergency department visits and hospital care. 

Seniors living in nursing homes should be able to cover their basic needs that are not provided by Medicaid or their facility, allowing them to age with dignity. They are already giving nearly all of their income to the state. Giving them this raise could provide a big boost in their health and happiness—not needing to choose between orthotics and a gift for their grandchild. We could argue that this doesn’t go far enough, but after nearly two decades without adjustment, this is a great place to start. 

Paul Shafer is an associate professor at the Boston University School of Public Health and co-director of the Boston University Medicaid Policy Lab. Monica Aswani is an assistant professor at the University of Alabama at Birmingham School of Health Professions.