What Happens to Your Social Security Check in a Nursing Home?

Understanding the implications for Social Security benefits is important when an individual requires nursing home care. Social Security benefits are a primary income source for many older adults and individuals with disabilities. How these benefits are handled changes based on whether the individual pays privately or receives assistance through programs like Medicaid. Navigating these financial aspects ensures benefits are appropriately applied to care costs while addressing personal needs and family support.

Social Security Benefits and Nursing Home Residency

Social Security benefits generally continue when an individual enters a nursing home. The Social Security Administration (SSA) is typically notified of a nursing home admission by the resident, their family, or the facility itself. This notification is important for the proper redirection or management of benefit payments.

Benefit payments may be sent directly to the individual, a designated representative payee, or in some cases, directly to the nursing facility. Direct deposit into the resident’s bank account is often recommended for security and convenience. If an individual is unable to manage their own finances, the SSA may appoint a representative payee. This can be a family member, a friend, or even the nursing facility itself, though some regulations exist to prevent conflicts of interest. A representative payee is responsible for using the benefits in the best interest of the beneficiary, covering their current maintenance needs such as food, housing, clothing, medical care, and personal items, and must also maintain records and report to the SSA.

For those receiving Supplemental Security Income (SSI), specific rules apply when entering a nursing home. If Medicaid pays for more than 50% of the cost of care, SSI benefits are typically reduced to a maximum of $30 per month. Full SSI benefits may continue for up to three months if the stay in a medical facility is certified by a physician as unlikely to exceed 90 days, and the individual needs to maintain their home to which they plan to return. This provision helps individuals retain their housing during short-term institutionalization.

Applying Social Security Income Towards Care Costs

The application of Social Security income towards nursing home care costs depends on the individual’s payment arrangement. For those paying privately, the Social Security check is considered part of their overall income, used to cover the full monthly cost of care. Average Social Security benefits, approximately $1,979 per month in 2025, typically cover only a fraction of nursing home expenses, as median monthly costs can range from $7,000 to over $10,000. This often necessitates additional funding sources or financial assistance programs to cover the substantial difference.

For individuals eligible for Medicaid, the process involves a “share of cost” or “patient liability” calculation. Most Social Security income, after certain allowable deductions, is required to be paid directly to the nursing home. Allowable deductions typically include a personal needs allowance and health insurance premiums. Once this calculated amount is contributed by the resident, Medicaid then covers the remaining balance. If, after deductions, there is no remaining income, Medicaid will pay the entire cost. Federal law generally prohibits nursing homes from seizing a patient’s income and assets, including Social Security payments, unless their accounts are in default.

Personal Needs Allowance

A specific provision for nursing home residents, particularly those receiving Medicaid, is the Personal Needs Allowance (PNA). This allowance is a portion of a resident’s monthly income they are permitted to keep for personal expenses. The purpose of the PNA is to cover items and services not provided by the nursing home or covered by Medicaid. These personal expenses can include clothing, toiletries, snacks, magazines, and hair styling services.

The federal minimum for the PNA is $30 per month, an amount established in 1988. States have the discretion to set higher PNA amounts, which can range from this federal minimum up to approximately $200 per month. This amount is protected and is not used to pay for the nursing home bill. Residents or their representative payees must manage PNA funds carefully, ensuring that accumulated savings from the allowance do not cause the resident to exceed Medicaid’s asset limits, which are typically around $2,000 for an individual.

Impact on Spousal and Dependent Benefits

When an individual enters a nursing home and seeks Medicaid assistance, specific rules are in place to mitigate financial hardship for a spouse remaining in the community. These are known as “Spousal Impoverishment Rules.” Two provisions are particularly relevant: the Community Spouse Resource Allowance (CSRA) and the Minimum Monthly Maintenance Needs Allowance (MMMNA).

The Community Spouse Resource Allowance allows the community spouse to retain a portion of the couple’s combined countable assets. For 2025, federal guidelines set the minimum CSRA at $31,584 and the maximum at $157,920, with states determining their specific allowance within this range. This ensures the spouse at home has sufficient resources for their own financial security. The Minimum Monthly Maintenance Needs Allowance allows a portion of the institutionalized spouse’s income to be transferred to the community spouse if their own income falls below a certain threshold. This allowance helps the community spouse meet their living expenses. For the period of July 1, 2025, to June 30, 2026, the federal minimum MMMNA for most states is $2,643.75, while the federal maximum, effective January 1, 2025, to December 31, 2025, is $3,948.

Social Security benefits for dependents, such as minor children or disabled adult children, are generally unaffected by a parent’s institutionalization. These benefits typically continue as long as the dependents meet their own eligibility criteria based on the parent’s work record. This ensures that dependent family members continue to receive the financial support they are entitled to, even when a parent requires nursing home care.