Long-Term Care Medicaid in Pennsylvania: 2026 Guide

In Pennsylvania, Medicaid is called Medical Assistance (MA). It is run by the Pennsylvania Department of Human Services (DHS), and eligibility is decided by your County Assistance Office (CAO). Long-Term Care Medicaid can pay for nursing home care and for care at home through Community HealthChoices (CHC) or the LIFE program. This guide explains the 2026 rules in plain language.

At a glance: Pennsylvania 2026 figures

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with the Pennsylvania Department of Human Services before relying on them.

What Long-Term Care Medicaid covers in Pennsylvania

Nursing home care. Medical Assistance pays for care in a certified nursing facility. You pay most of your income toward the cost each month, and MA pays the rest.

Care at home and in the community. Pennsylvania’s main long-term care program for adults is Community HealthChoices (CHC), a managed care program. CHC covers people 21 and older who have both Medicare and Medicaid, or who need a nursing-facility level of care and get long-term services at home or in a nursing home. A CHC health plan arranges services such as personal assistance, home health care, adult day care, home-delivered meals, home changes and respite. Three CHC plans serve every part of the state, and you can change plans at any time.

LIFE (Living Independence for the Elderly) is Pennsylvania’s name for the national PACE program. It is a choice instead of CHC for people 55 and older who need a nursing-facility level of care, live in an area with a LIFE provider and can be safely served at home. A LIFE care team provides and coordinates all care, often at a LIFE center.

Assisted living. Pennsylvania’s Medical Assistance generally does not pay for room and board in personal care homes or assisted living residences. Whether a CHC plan can pay for any care services in these settings depends on the plan and the setting.

Who qualifies

A person generally must:

• be 65 or older, or disabled (21 or older for CHC; 55 or older for LIFE);
• live in Pennsylvania and be a U.S. citizen or qualified non-citizen;
• be nursing facility clinically eligible (NFCE). For home and community care, the Independent Enrollment Broker (IEB) arranges an in-person assessment at home, in the hospital or in a nursing facility to decide this;
• meet the income and asset rules below, as decided by the County Assistance Office.

Income rules

Pennsylvania has two routes:

• Special income limit: in 2026, gross monthly income of $2,982 or less. This is the route for home and community-based services through CHC.
• Medically needy: a nursing home applicant whose income is above $2,982 can still qualify if their income is not enough to pay the nursing home’s cost. They pay their income toward their care, and MA pays the rest.

Pennsylvania’s handbook should be checked before this is described.

Once you are on Medical Assistance in a nursing home, most of your income goes to the facility. You keep a personal needs allowance of $60 a month, and money can be set aside for a spouse at home and for health insurance premiums.

Asset rules

In 2026, a single applicant under the special income limit can keep $2,000, and Pennsylvania disregards (ignores) another $6,000, so the effective limit is about $8,000. Under the medically needy route, the limit is $2,400. When both spouses need care and apply, Pennsylvania lets each spouse keep $2,400, or $4,800 for the couple.

Countable assets include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above small amounts, and real estate other than the home.

Usually exempt:

• Your home (equity up to $752,000) if you live there or plan to return, or a spouse or dependent relative lives there
• One vehicle
• Household goods and personal belongings
• Irrevocable burial reserves and burial spaces
• Some income-producing property

Spousal protections

• Assets: The spouse at home can keep a Community Spouse Resource Allowance of at least $32,532 and up to $162,660 in 2026, plus the home, one car and belongings.
• Income: The spouse at home keeps their own income. If it is below $2,705 a month (from July 1, 2026), part of the applicant’s income can go to them, plus extra for high housing costs, up to $4,066.50 a month.

Look-back and penalties

When you apply, Pennsylvania looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

• Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
• Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
• Selling a house or car to a relative for much less than it is worth.
• Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($12,811.50 a month).

Example: Suppose you gave your son $50,000 three years before applying. $50,000 divided by $12,811.50 is about 3.9 months without Medical Assistance payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in Pennsylvania

Pennsylvania’s Estate Recovery Program is run by DHS.

• What is recovered: Medical Assistance paid for long-term care, including nursing facility care, home and community-based services and related services, from age 55 until death, for services on or after August 15, 1994.
• When it is put off: federal rules prevent recovery while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
• Hardship waivers: DHS can waive or postpone recovery in some situations, such as a home that was cared for by a family caregiver or property that is a survivor’s source of income. Ask the Estate Recovery Program for the current rules.
• Family members and executors can contact the DHS Estate Recovery Program directly with questions.

How to apply

• Online: COMPASS, Pennsylvania’s benefits website
• By phone: the DHS Consumer Service Center for Health Care Coverage, which has taken long-term care applications by phone since June 16, 2025
• In person or by mail: at your County Assistance Office
• For home and community care (CHC or LIFE): contact the Independent Enrollment Broker (IEB). The IEB schedules the in-person assessment, helps complete the Medical Assistance application and sends it to the CAO, and explains the CHC plans in your area. To choose LIFE, contact a LIFE provider or the IEB.

Phone numbers for each are on the DHS Apply for Long-Term Care Services page.

Gather what you can before you apply. The caseworker may ask for:

• Photo ID, Social Security card and Medicare card
• Proof of age and of U.S. citizenship or immigration status
• Proof that you live in the state (for example, a utility bill or lease)
• Proof of all income: Social Security award letter, pension statements, annuity statements
• Bank, credit union and investment statements (often for the full 60-month look-back period)
• Deeds, property tax bills and the value of any real estate
• Life insurance policies (showing cash value) and prepaid funeral or burial contracts
• Vehicle titles
• Health insurance cards and long-term care insurance policies
• Power of attorney or guardianship papers, if someone is applying for you
• For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in Pennsylvania

• DHS and your County Assistance Office: Medical Assistance applications and eligibility.
• Independent Enrollment Broker and the CHC Helpline: help applying for long-term services, assessments and choosing a CHC plan.
• Area Agencies on Aging and the PA Link to Aging and Disability Resources: local information on long-term care options.
• PA MEDI (formerly APPRISE): Pennsylvania’s free Medicare counseling program (SHIP), through the Department of Aging.
• Pennsylvania Long-Term Care Ombudsman Program: free advocates for residents of nursing homes, personal care homes and assisted living.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including Pennsylvania:

• Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
• Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). Pennsylvania’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect Pennsylvania’s limit.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

• Pennsylvania Community HealthChoices

Frequently asked questions

What is Community HealthChoices? It is Pennsylvania’s managed care program for long-term services. A CHC health plan coordinates care at home or in a nursing home for people 21 and older who have Medicare and Medicaid or need nursing-facility level care.

What is the difference between CHC and LIFE? Both help people live at home. LIFE is for people 55 and older and provides all care through one local care team, often at a day center. CHC uses a health plan and a network of providers.

Can I keep more than $2,000? Under the special income limit, Pennsylvania ignores an extra $6,000, so a single person can keep about $8,000. Under the medically needy route, the limit is $2,400. When both spouses need care and apply, each spouse can keep $2,400 ($4,800 for the couple).

Does Medical Assistance pay for assisted living in Pennsylvania? Generally not for room and board. Ask DHS or your CHC plan whether any care services can be covered in a specific setting.

How much can my spouse keep? In 2026, at least $32,532 and up to $162,660 in assets, plus the home, a car and belongings, and income of at least $2,705 a month.

Will the state take my home after I die? Pennsylvania can seek repayment for long-term care paid after age 55, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.

Figures change periodically. Double-check current amounts with the Pennsylvania Department of Human Services before relying on them.

Sources

• DHS Long-Term Care Handbook, 468 Appendix A
• DHS Long-Term Care Handbook, 440 Appendix A (resources)
• DHS, Apply for Long-Term Care Services
• DHS, Apply for Community HealthChoices
• DHS, Community HealthChoices
• DHS, LIFE program
• DHS, Estate Recovery Program
• CMS, 2026 SSI and spousal impoverishment standards
• Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.