Pennsylvania

What is Pennsylvania Medicaid Long-Term Care?

Medicaid is a health care program designed for low-income individuals of all ages. This section focuses on long-term care Medicaid eligibility for senior residents of Pennsylvania, aged 65 and older. In addition to nursing home care and assisted living services, PA Medicaid covers non-medical support services to help frail seniors live at home or with family. There are three categories of Medicaid long-term care programs available for eligible seniors in Pennsylvania.

What are the Categories of Medicaid Long-Term Care Programs in Pennsylvania?

What is Institutional / Nursing Home Medicaid?

This is an entitlement program; anyone who qualifies will receive assistance. Care is provided solely in nursing homes.

What are Medicaid Waivers / Home and Community-Based Services (HCBS)?

This is not an entitlement program; there are limited slots and waiting lists. It aims to delay the need for nursing home care, with services provided at home, adult day care, or in assisted living.

What is Regular Medicaid / Aged Blind and Disabled?

This is an entitlement program. If eligibility criteria are met, long-term care benefits like personal care assistance and adult day care may be available.

What are the Income & Asset Limits for Medicaid Eligibility in Pennsylvania?

Eligibility criteria vary by Medicaid program. Financial eligibility requirements change annually, vary by marital status, and Pennsylvania offers several pathways to qualify.

What are the Eligibility Requirements for a Single Nursing Home Medicaid Applicant in 2025?

A single Nursing Home Medicaid applicant must meet the following criteria in 2025:
– Income: Under $2,901 per month
– Assets: Under $2,000
– Level of Care: Nursing Home required

What Are the 2025 Income and Asset Limits for Various Medicaid Programs?

What is the Definition of Income & Exceptions in Pennsylvania Medicaid?

Countable income includes wages, alimony, pension payments, Social Security Disability, and more. Certain payments like Holocaust restitution, VA Aid & Attendance, or Housebound benefits are not counted.

How Does Medicaid Count Income for a Couple?

For Nursing Home Medicaid or Medicaid Waivers, only the applicant’s income is counted. The non-applicant spouse’s income is disregarded, and they may be entitled to a Community Spouse Maintenance Needs Allowance (CSMMNA), which ensures the non-applicant spouse has enough income to avoid spousal impoverishment.

What are the Asset Limits and Exceptions in Pennsylvania Medicaid?

Countable assets include stocks, bonds, investments, and bank accounts. Non-countable assets include personal belongings, vehicles, a primary home, and certain retirement accounts. The IRA/401k of a non-applicant spouse is exempt.

How Does Medicaid Treat Assets for a Couple?

In a married couple, assets are considered jointly owned. The non-applicant spouse can retain up to 50% of the couple’s assets, up to $157,920, under the Community Spouse Resource Allowance (CSRA).

What is Medicaid’s 5-Year Look-Back Rule?

Medicaid will review a 5-year period preceding an application to ensure that no assets were transferred or gifted below market value to meet asset limits. Violating the Look-Back Rule results in a Penalty Period during which the applicant is ineligible for Medicaid.

What are Pennsylvania Medicaid’s Home Exemption Rules?

If the applicant or their spouse resides in the home, the home may be exempt from Medicaid’s asset limits. The home equity interest is capped at $730,000 in 2025. However, the home is not exempt from Medicaid’s Estate Recovery Program.

What are the Medical and Functional Need Requirements for Medicaid in Pennsylvania?

Applicants must have a functional need for long-term care. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Specific services may require additional functional needs, such as the inability to live safely at home without modifications.

How Can Seniors Qualify for Medicaid When They Exceed Financial Limits?

Pennsylvania residents over 65 may qualify for Medicaid through the Medically Needy Pathway, Asset Spend Down, or Medicaid Planning.

What is the Medically Needy Pathway?

This program allows individuals with income above the Medicaid limit to spend down their income on medical expenses, such as nursing home bills, to become eligible for Medicaid.

How Can One Spend Down Assets to Qualify?

Seniors can spend down excess assets on non-countable assets like home modifications or funeral expenses. Proper documentation must be kept to prove the assets were not gifted or sold below market value.

What is Medicaid Planning?

Medicaid Planning allows individuals to work with professionals to help them qualify for Medicaid and protect assets like their home from Medicaid’s Estate Recovery Program.

What Specific Medicaid Programs Does Pennsylvania Offer for Seniors?

Community HealthChoices (CHC) Program

This program offers long-term care services, such as adult day care, personal care, and home health services, for seniors and people with disabilities. Beneficiaries can self-direct their care through the Services My Way option.

Program of All-Inclusive Care for the Elderly (PACE)

A combined program offering both Medicaid and Medicare benefits, including long-term care services, dental, and eye care.

Money Follows the Person Program

This program helps individuals transition from institutional care back to their home or the community.

How Do You Apply for Medicaid in Pennsylvania?

Seniors can apply for Medicaid online via COMPASS, submit a paper application to their local County Assistance Office (CAO), or apply by phone. It is recommended that applicants ensure they meet all eligibility criteria before applying.