Advocating for Increased Personal Needs Allowance for In-Home Care

You may have heard that Washington is near the top on the Long-Term Services & Supports State Scorecard issued by AARP, AARP Foundation, The Commonwealth Fund, and the SCAN Foundation. The scorecard measures how well we care for older adults, people with physical disabilities, and family caregivers. Currently we are #2 to Minnesota. At times, on previous scorecards over many years, we have held the #1 spot.


Click on the image above to open a two-page document from DSHS Aging and Long-Term Support Administration.

The Scorecard measures a broad range of long-term services and supports (LTSS), including day-to-day help needed by people with long-term conditions, disabilities, or frailty (e.g., personal hygiene, complex care medications, wound care, housework, meals, and more) as well as caregiver support services. In Washington state, Medicaid-paid LTSS and caregiver support services are provided via Area Agencies on Aging and community partners.

For those who may not be familiar with Medicaid LTSS, clients are both low-income and unable to perform certain activities of daily living. In King County, inquiries about LTSS typically go through Community Living Connections—a service we coordinate and fund. Community Living Connections can pre-screen and help with applications to DSHS Home and Community Services. Once the client is qualified for services, Home and Community Services refers them to Aging and Disability Services for case management. Our case managers further assess client needs and support clients in hiring in-home providers.

Long-term services and supports are not free of charge. Clients who receive Medicaid services are required to pay a co-pay, which is calculated by subtracting a Personal Needs Allowance (PNA) from their monthly income. Currently, those who receive in-home LTSS are only able to keep $1,074 of their monthly income to pay for rent, utilities, food, and other essential items. Everything else goes toward paying for the cost of their LTSS care—which could be a lot if their monthly income is around $3,000. You can get LTSS in Washington state with that much income.

Not only is it difficult to live on $1,074, DSHS Developmental Disabilities Administration clients receiving Medicaid services are able to keep substantially more of their personal funds—currently a generous $2,349 per month. We don’t begrudge that amount; rather, there is an equity issue that needs to be addressed.

Legislative Hotline toll-free 1-800-562-6000Learn more by reading “Increasing Washington’s Personal Needs Allowance will promote client choice in long-term care,” a DSHS ALTSA position paper that explains why the department requested a PNA increase for in-home clients in their agency budget. We are grateful for the department’s understanding, and we know that legislative advocacy is needed to ensure the right action.

Recently Aging and Disability Services case manager Mark Bernstein shared these anecdotes from real life situations he has encountered:

“Clients have opted out of needed services as their financial participation was an additional cost unsustainable on an already inflexible budget of a limited fixed income. Even with the explanations of the services received in return for the financial responsibility, the possible loss of discretionary monies to many potential and current clients on a fixed income is traumatic and often a deal breaker.

“Clients are challenged to meet other monthly expenses (e.g., utilities, food, rent) due to the cost of financial participation, despite receiving other benefits such as food, housing subsidy and/or energy assistance. For those who do not have housing subsidies, the PNA does not even begin to address the rise in the costs of housing.

“All living costs consistently increased over the years without a corresponding and realistic adjustment for PNA. Given that those who do have a financial participation typically receive Social Security only (some may have an additional source of income such as a small pension, a spousal benefit, or VA benefits), the participation amount can be a very large percentage of total monthly income. A reasonable (or no) PNA would provide for increased financial stability for the client with more discretionary monies that would enable a client better means to live independently.

“Clients have been discharged from services by homecare agencies due to missed payments and overdue balances. This could be due to unexpected expenses, a client’s challenge to manage finances and pay bills, or lack of understanding of what is expected of them. For the most part, homecare agencies are very tolerant for missed payments, but those missed payments grow into an even larger balance that, even with a payment plan, clients are unable to meet. A higher PNA (or even elimination) would result in lower (or no) client financial participation, which would be in both the client’s and agency’s best interest.

“Financial participation for in-home services distracts all of us—agency personnel and case managers alike—by forcing us to be financial agents who spend considerable time with explanations, monitoring, mediating, and even handling collections as we try to ensure that our clients in need will not lose services.”

I appreciate the real-life scenarios that Mark shared and know that every one of our case managers has similar stories. They are effective advocates for their clients in every way. Legislative advocacy, however, is up to the ADS Advisory Council and other Aging Network advocates.

The Personal Needs Allowance for in-home care should reflect the current cost of living, on par with other state allowances, or be eliminated; otherwise, it is a barrier to access of much-needed long-term services and supports.

If you agree, I encourage you to contact your state legislators. The easiest way to do that is via the State’s Legislative Hotline: 1-800-562-6000.

Dick WooContributor Dick Woo chairs the Seattle-King County Advisory Council on Aging & Disability Services. He welcomes input from readers via e-mail ( as well as applicants for open positions on the council. For more information, visit

This article originally appeared in the December 2021 issue of AgeWise King County.