This bill would add a new section to the South Carolina Code to increase and index the personal needs allowance (PNA) for Medicaid-eligible nursing home residents and certain other institutional or residential care clients. The PNA is the portion of a resident’s income that is set aside each month for clothing and other personal expenses before the resident’s share of care costs is calculated. Under the bill, beginning January 1, 2025, the allowance would be adjusted annually by the Social Security cost-of-living adjustment, subject to federal maximums, and the state-level allowance in effect on that date would have to be at least $100.
The bill also requires the Department of Health and Human Services to disregard accrued PNA amounts as an asset for nursing home residents who were in a nursing home as of June 1, 2024, for the duration of their stay, and to seek federal Medicaid state plan approval for that treatment. It clarifies that the PNA is for personal items and services not covered by Medicaid, listing examples such as clothing, toiletries, haircuts, books, postage, cigarettes, and cell phone bills, while prohibiting nursing homes from requiring residents to use PNA funds for Medicaid-covered items, hygiene products, food, or social activities.
In terms of state-law impact, the bill would create a new statutory requirement governing how South Carolina calculates Medicaid residents’ contributions toward nursing facility care and how the state treats personal needs funds. It would also impose an ongoing fiscal obligation by directing the General Assembly to appropriate recurring funds beginning in fiscal year 2025-2026 to cover the increased allowance. Because the bill ties implementation to federal Medicaid rules, it would also require administrative action and federal approval for part of the asset-disregard provision.
The general sentiment reflected by the bill itself is supportive of nursing home residents by preserving more of their income for personal use and protecting them from being compelled to spend those funds on basic necessities or facility activities. No committee transcripts or recorded votes were provided, so there is no direct evidence of debate, but the measure appears framed as a consumer-protection and cost-of-living adjustment policy for low-income long-term care residents.
The main points of potential contention are fiscal and administrative. The bill would require recurring state funding, which could raise budget concerns, and the asset-disregard provision depends on approval from the Centers for Medicare and Medicaid Services, which could affect implementation. There may also be policy debate over the scope of items explicitly allowed or prohibited for PNA use, and over whether the increase should be automatic and indexed to Social Security COLA.
The bill would add Section 44-7-95 to Title 44 of the South Carolina Code, establishing a statutory framework for the personal needs allowance of Medicaid-eligible nursing home and certain residential care residents. It would require annual COLA-based adjustments, set a minimum state allowance of at least $100, prohibit facilities from directing PNA funds toward Medicaid-covered items or required food/social activities, and direct the Department of Health and Human Services to seek federal approval for an asset disregard for certain residents. It also creates a recurring appropriations obligation beginning in FY 2025-2026 to fund the increased allowance.
The bill’s apparent sentiment is favorable toward nursing home residents and other Medicaid beneficiaries, aiming to protect a larger share of their income for personal use and to prevent facilities from shifting ordinary costs onto residents’ personal funds. Because no committee discussion or votes were provided, there is no recorded legislative debate to gauge opposition or support, but the text suggests a broadly sympathetic consumer and elder-care policy approach.
Likely points of contention are the fiscal impact on the state budget, since the bill requires recurring appropriations to cover the higher allowance, and the administrative complexity of implementing annual adjustments and obtaining federal Medicaid approval for the asset-disregard provision. Another possible area of disagreement is the policy choice to mandate a minimum $100 allowance and to specify allowable and prohibited uses of PNA funds, which could draw scrutiny from budget writers, Medicaid administrators, and long-term care providers.