Living on $45 a Month in a Nursing Home: What Medicaid Doesn’t Cover
When I teach CNA students, I tell them this:
In our state, for Medicaid residents in nursing homes, Social Security income is used to cover part of the monthly bill. Residents receive a $45 personal needs allowance. The rest of their Social Security goes toward room and board.
The nursing home provides food, a semi-private room, basic toiletries, medical equipment, and incontinence products.
That’s it.
What it does not pay for is clothes, books, phones, preferred hygiene products, postage, streaming services, haircuts, snacks, gifts, or hobbies.
I ask my students to imagine what they would buy with $45 a month.
Their lists always start confidently:
• a phone
• hair products
• fast food
• books
• subscriptions
Then the lists trail off.
Eventually, someone says:
“I couldn’t do that on $45.”
That’s the point.
Yes, residents get room and board.
They do not get:
• the shampoo they like
• deodorant that works for them
• brand-name lotion
• a can of Coke
• new socks
• a sweater that fits
• Netflix or Spotify
Laundry loses clothes—all the time. Replacements cost money they don’t have.
A basic TracFone plan costs more than $45 a month. A haircut costs more than $25.A 12-pack of soda is $10.
Residents have to make choices:
Underwear or socks.
ChapStick or shampoo.
I wish more people knew this.
I wish people knew they don't need to wait for Christmas, they can drop off:
• reading glasses
• deodorant
• shampoo
• new socks
• sweaters
• ChapStick
• a six-pack of Sprite
And it would matter.
You don’t have to solve long-term care.
You don’t have to understand Medicaid policy.
Just know that for many people living in long-term care, $45 a month is all there is.
And a pair of reading glasses, a new T-shirt, a pair of socks, a sweater, a new puzzle, or a candy bar can change a day.
To protect resident privacy, identifying details in this story have been changed. The situations described reflect real issues encountered in long-term care.
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