Understanding How much of social security can you keep if at a nursing home?

Oct 28, 2025 4 min read •

senior care medicaid Financial Planning

Medicaid covers more than half of all nursing home residents in the U.S., making its rules crucial for financial planning. Understanding how much of social security can you keep if at a nursing home? depends heavily on whether Medicaid is covering the costs and what type of Social Security benefit you receive.

Quick Summary

The amount you can keep varies depending on your benefit type and whether Medicaid covers your care. For Medicaid residents, income often goes toward care costs, leaving a small monthly personal needs allowance. For others, benefits are unaffected, but may not cover expenses.

Key Points

Medicaid is a Major Factor: The amount of Social Security you can keep is most dependent on whether Medicaid is covering your nursing home care.
Reduced SSI for Long-Term Medicaid: If Medicaid pays for long-term care, your SSI benefit is typically reduced to a small Personal Needs Allowance (PNA), with the rest going toward your care.
SDI/Retirement Benefits as Patient Liability: For those on Social Security retirement or disability, the benefits serve as a patient liability to pay for Medicaid-covered care, minus the PNA.
Personal Needs Allowance (PNA): This is the small monthly amount you keep for personal expenses. The amount varies by state, but is federally mandated to be at least $30.
Spousal Protections Exist: If one spouse remains at home, spousal impoverishment rules help protect their income and assets, potentially allowing them to keep some of the institutionalized spouse's income.
Temporary Stay Exception: For SSI recipients, a stay of 90 days or less in a nursing home does not affect the amount of benefits you can keep, provided the SSA is notified.

Your Social Security Income and Long-Term Care

When facing the prospect of nursing home care, one of the most pressing concerns is managing finances and understanding what happens to existing income streams, like Social Security. The key determining factor is often whether you will be relying on Medicaid to cover the exorbitant costs of long-term care. The rules differ significantly for those who qualify for Medicaid versus those who pay privately.

The Impact of Medicaid on Your Benefits

For many seniors, Medicaid is the primary payer for nursing home care after personal savings are depleted. However, Medicaid is a needs-based program with strict income and asset limits. When a person is approved for long-term care Medicaid, a patient liability is calculated to determine their contribution to the cost of care. For an institutionalized individual, nearly all monthly income—including Social Security, pensions, and other sources—is used to pay the nursing home. The patient is permitted to keep only a small portion, known as the Personal Needs Allowance (PNA).

Supplemental Security Income (SSI): If your primary benefit is SSI and Medicaid is paying for over half of your care, your SSI benefit is automatically reduced to a federal minimum of $30 per month. Some states provide an additional supplement, but the amount remains minimal. Your SSI payments may continue for up to 90 days at the full rate if your stay is temporary and you need the funds to maintain your home. You must inform the Social Security Administration (SSA) and your doctor must provide a statement confirming the short duration of the stay.
Retirement or Disability Benefits (SSDI): If you receive Social Security retirement or disability benefits and enter a Medicaid-funded nursing home, your benefits will be directed toward your care costs. You will be allowed to keep the state's PNA, and the rest is paid to the facility. The amount of your benefits is not reduced by the SSA itself, but the funds are reallocated to pay for your medical expenses.

What is a Personal Needs Allowance (PNA)?

The PNA is a small monthly amount intended for personal items not covered by Medicaid, such as haircuts, toiletries, and snacks. The amount of the PNA varies significantly by state, and while the federal minimum is $30 per month, many states offer a higher amount. This state-specific PNA is the only portion of your income you are guaranteed to keep after your patient liability is paid. Because the PNA is part of the Medicaid program, you must notify your state Medicaid agency when you enter a nursing facility to ensure proper calculation and payment. Accumulating excess funds in your personal account from your PNA can potentially impact your continued eligibility for Medicaid, as there are asset limits.

The Role of Spousal Impoverishment Rules

When only one spouse in a married couple needs Medicaid-funded nursing home care, special rules known as Spousal Impoverishment provisions are designed to protect the financial resources of the healthy spouse (the community spouse) still living at home. These protections allow the community spouse to keep a significant portion of the couple's assets and, in some cases, a portion of the institutionalized spouse's income. This is governed by the Minimum Monthly Maintenance Needs Allowance (MMMNA).

If the community spouse's income is below a certain threshold (the MMMNA), a portion of the institutionalized spouse's income can be reallocated to the community spouse to ensure they have enough to live on. This is a critical provision that helps prevent the at-home spouse from becoming impoverished while their partner receives long-term care.

The Scenario for Private Pay Residents

If you or your family are paying for a nursing home privately, without any Medicaid assistance, your Social Security benefits are not affected by Medicaid rules. You will continue to receive your full benefit amount directly. However, it is important to remember that average Social Security benefits are typically far below the monthly cost of a nursing home. Therefore, your benefits will cover only a fraction of the total expense, and other assets and income will be required to fund your care. This is a primary reason many seniors eventually transition to Medicaid after exhausting their private funds.

Navigating the Differences: A Comparison


Scenario	SSI Benefits	SSDI / Retirement Benefits	Key Takeaway
Medicaid-Funded (Long-term)	Reduced to PNA (federally mandated $30 min., but often supplemented by states)	Paid to nursing home as patient liability, with recipient keeping state's PNA.	Significant portion of income goes toward cost of care.
Medicaid-Funded (Temp. < 90 days)	Unchanged, providing SSA is notified and stay is verified as temporary.	Not impacted directly; benefits used to maintain housing costs.	Full benefit retained to maintain permanent housing during short stay.
Private Pay Resident	Retained in full; paid directly to the recipient.	Retained in full; paid directly to the recipient.	Full benefit is kept, but covers only a small portion of care costs.
Spousal Impoverishment	Portion may be reallocated to community spouse if their income is below MMMNA.	Portion may be reallocated to community spouse if their income is below MMMNA.	Income protections exist for the healthy spouse at home.

Making Informed Decisions

Financial planning for long-term care is complex and requires careful consideration of all income sources, including Social Security. The path you take—Medicaid or private pay—determines how much of your Social Security income you can retain. In most Medicaid-funded scenarios, the amount you keep is limited to the state-defined personal needs allowance. Therefore, it is crucial to understand the rules and eligibility requirements for your specific situation. Consulting an elder law attorney or a qualified financial advisor can provide invaluable guidance. These professionals can help you navigate the intricacies of Medicaid, spousal protections, and asset management, ensuring you are prepared for the financial realities of long-term care.

More information on the temporary institutionalization rule for SSI can be found on the Social Security Administration's website.

Frequently Asked Questions

No, your Social Security benefit is not automatically reduced. The amount you can keep depends on whether you are using Medicaid to pay for your care. If you are paying privately, your Social Security is unaffected.

When you are in a Medicaid-funded nursing home, your Social Security retirement income will be used to pay for your care. You will be allowed to keep a small Personal Needs Allowance, with the remainder going to the facility.

The PNA varies by state. The federal minimum is $30 per month, but many states offer a higher amount. This money is for personal items like clothing, snacks, and toiletries.

A nursing home cannot legally seize your Social Security checks. However, in a Medicaid-funded scenario, your income is directed toward your cost of care. If you are unable to manage your own finances, the facility may be designated as your representative payee to handle payments.

If you receive SSI and your nursing home stay is for 90 days or less, you can keep your full benefit. You must notify the SSA in writing, and your doctor must provide a statement confirming the temporary nature of the stay.

Your spouse's own Social Security benefits are not affected. Furthermore, spousal impoverishment rules allow them to keep a certain amount of your income and assets to ensure they are not left without resources.

The federal minimum PNA of $30 has been in place for a long time. However, many states adjust their state-specific PNA amounts periodically, and you should check with your state's Medicaid agency for the most up-to-date figure.

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.