How the Home Maintenance Deduction Helps Nursing Home Residents Keep Up with Home Expenses

When someone enters a nursing home, it’s common for families to feel overwhelmed—not just emotionally, but financially too. One of the biggest surprises for many people is how Medicaid handles the person’s income once they qualify for nursing home Medicaid.

This is where the Home Maintenance Deduction can make a difference. It’s a little-known rule that can help protect some of a nursing home resident’s income for a short period of time, allowing them to keep up with basic costs to maintain their home while they’re in the nursing home.

A Quick Overview of Nursing Home Medicaid

Medicaid is a government program that helps pay for nursing home care when someone can’t afford it on their own. But it’s important to understand that Medicaid is designed to be the payer of last resort. That means before Medicaid pays anything, the person’s gross monthly income (that’s the amount before any deductions—like taxes or insurance—are taken out), less certain income deductions, must first be paid toward their nursing home costs.

This payment is called the patient pay responsibility amount or Medicaid co-pay. Medicaid then covers the rest of the nursing home bill, up to the state’s Medicaid reimbursement rate for that facility.

What Deductions Are Allowed from Income?

Before Medicaid figures out how much of a person’s income goes to the nursing home, a few standard deductions are subtracted from gross income:

• Medicare Part B premium and any other supplemental insurance premiums

• A $60 personal needs allowance (as of 2025), which is the small amount the resident can keep for things like toiletries, haircuts, or snacks.

• If eligible, the Home Maintenance Deduction, which sets aside some income to help pay basic home expenses for a limited time

Aside from these deductions, the rest of the person’s income must go toward the nursing home each month.

Because Pennsylvania’s Medicaid asset limits are very low (typically $2,400 or $8,000 depending on income), most people don’t have savings to fall back on. This is why keeping up with home expenses—like utilities, taxes, or insurance—can be nearly impossible once Medicaid starts. That’s where the Home Maintenance Deduction (HMD) can provide some short-term breathing room.

What Is the Home Maintenance Deduction?

The Home Maintenance Deduction lets certain nursing home residents keep $989.10 per month of their income (as of 2025) for up to six months, to help maintain their home while they’re away.

This amount is set by the state and is updated each January. It doesn’t matter what your actual home costs are—Medicaid uses the fixed HMD amount. The idea behind this deduction is simple:

👉 If someone is only in the nursing home for a short time and plans to return home, this deduction helps make sure they don’t lose their home while they’re gone.

Who Qualifies for the Home Maintenance Deduction?

To qualify for the deduction, three main conditions must be met:

1. A doctor must certify that the person is expected to return home within six months of entering the nursing home.

2. The person must have a home—either owned, rented, or shared—and be responsible for the bills.

3. The person must be single or, if married, both spouses must be in nursing homes. (If one spouse is still living at home, Medicaid uses different income rules to protect that spouse.)

How It Works

Think of the Home Maintenance Deduction as a way to temporarily set aside a portion of your monthly income to help keep your home going while you’re in the nursing home. Medicaid doesn’t automatically give this deduction—you have to qualify—but if you do, it can make a big difference.

Here’s a simple example:

• John’s gross monthly income: $2,000

• Medicare premium: $174.70

• Personal needs allowance: $60

• Home Maintenance Deduction: $989.10

Here’s how Medicaid figures out John’s monthly payment to the nursing home:

1. Start with John’s gross income: $2,000

2. Subtract his Medicare premium: $174.70

3. Subtract his $60 personal needs allowance (the amount he can keep for himself)

4. Subtract the $989.10 Home Maintenance Deduction for his home

   
   

After these deductions, John’s remaining income is $776.20. That amount is what he would pay to the nursing home each month, and the rest can be used to help cover his home’s basic expenses—like the mortgage, utilities, or taxes—while he’s away.

The Home Maintenance Deduction can only be applied for up to six months, starting from the month of admission to the nursing home. In order to qualify, a doctor must complete the MA-51 form certifying that the person is expected to return home within that six-month period.

It’s important to understand that the six-month clock starts running when the person is admitted, not when the doctor signs the form. If the certification happens later, the deduction doesn’t get extended beyond that original six-month window—it simply applies to the remaining months.

Because of this, it’s best to have the doctor complete the MA-51 as early as possible so that the individual can receive the full benefit of the deduction for the entire six-month period.

Real-Life Examples

• Returning Home Example:

  
  

  Ann enters a nursing home on January 10. Her doctor says she is likely to return home within six months. She qualifies for the HMD starting in January and can use it through June to keep up with her home expenses.

  
  

• Later Certification Example:

  
  

  Samuel moves into a nursing home on February 1, but the doctor doesn’t initially expect him to return home. In April, his condition improves, and his doctor updates the MA-51 to say he can return home within six months. He becomes eligible for the deduction starting in April and can use it through July.

  
  

• Married Couple Example:

  
  

  Brian and Betty, a married couple, are both admitted to a nursing home. Their doctor certifies that both plan to return home. Medicaid allows only one spouse to receive the deduction, so they choose Brian. He receives the deduction for six months to help maintain their home.

Why This Deduction Matters

For many families, the Home Maintenance Deduction can be the difference between keeping a home ready for someone’s return—or losing it because there wasn’t enough income to cover the bills during a nursing home stay.

Because almost all income goes toward nursing home costs, very few people can afford to maintain their home once Medicaid starts paying. This deduction provides a temporary but meaningful cushion.

It’s important to act quickly: the deduction depends on a timely doctor’s certification and communication with the County Assistance Office. If it’s overlooked, the opportunity to use it can be lost.

We’re Here to Help

At Crane Law, PC, we help families understand how Medicaid works and find ways to protect what matters most—including their homes. The Home Maintenance Deduction is one of several planning tools that can help ease the financial strain during a nursing home stay.

Medicaid planning is never one-size-fits-all. Every family’s situation is unique, and thoughtful planning can make a significant difference—especially when nursing home care can cost more than $350 per day. If you or a loved one has recently entered a nursing home and hopes to return home, we can help determine eligibility for the deduction and guide you through the application process.

👉 Contact us today to schedule a consultation. Your home, your nest egg, and your peace of mind matter.