Updated September 6, 2026. Quick answer: In North Dakota, a Medicaid nursing-facility resident’s Personal Needs Allowance (the state uses different terminology; see below) is $118.00/Month; the amount of their own income they keep for personal use each month, with the rest going to the facility as the patient-pay amount toward the cost of care. That is well above the $30/month federal floor set in 1988 and never raised since. North Dakota Dept. of Health & Human Services, Non-ACA Medicaid Policy Manual, “Income Levels 510-05-85-40” (N.D.A.C. Section 75-02-02.1-40 et seq.) states the figure directly.
Why North Dakota’s figure isn’t the federal floor
Federal Medicaid law requires only a $30-a-month personal needs allowance as a floor; a state is free to set its own, higher figure by statute, regulation, or agency policy. North Dakota has done exactly that, setting $118.00/Month, per the manual section revised July 1, 2026 (Release 26.5).
What the allowance covers, and what it doesn’t
The personal needs allowance pays for the things a facility’s daily rate doesn’t cover: clothing, haircuts, snacks, a phone or television, small personal purchases. It is deducted before the rest of a resident’s income is applied to the facility bill as the patient-pay (or post-eligibility treatment of income, PETI) amount. It is not extra money on top of what Medicaid already pays the facility; it is the one slice of a resident’s own income that Medicaid rules guarantee the resident, not the facility, keeps.
A note on the name
North Dakota calls this the “nursing care income level,” not “personal needs allowance”; the identical concept (the amount of income a resident may retain; the excess goes to cost of care).
| Citation | North Dakota Dept. of Health & Human Services, Non-ACA Medicaid Policy Manual, “Income Levels 510-05-85-40” (N.D.A.C. Section 75-02-02.1-40 et seq.) |
| What it says | “Nursing care income level. The nursing care income level is $118 per month and must be applied to residents receiving psychiatric or nursing care services in nursing facilities, the state hospital, Prairie Saint John’s, a Psychiatric Residential Treatment Facility (PRTF), or receiving swing bed care in a hospital.” |
Figures verified against the North Dakota DHHS Non-ACA Medicaid Policy Manual section 510-05-85-40 (revised July 1, 2026, Release 26.5), N.D.A.C. chapter 75-02-02.1 and 42 U.S.C. 1396a(q) (Cornell LII) on September 30, 2026.
Every citation on this page was read directly from the state’s own Medicaid agency, administrative code, or official eligibility manual this session. General information, not legal or financial advice; a figure this specific can change with a budget cycle or a rule amendment, and a facility or state caseworker has the final say on any individual case.