Here you'll find essential information about eligibility and financial criteria specific to Pennsylvania. We’ve streamlined the details to make it easy to understand and navigate. Follow the provided links for more in-depth information on topics that apply to all states.
The programs outlined here are comprehensive of what the state of Pennsylvania offers residents. However, these are not your only options; many other financial options are available. When searching for assistance options, it’s important to explore all avenues to find a solution that truly fits your needs. You can review the additional resources on this website to learn more.
Institutional or Nursing Home Medicaid provides financial assistance for individuals who require a high level of care and reside in a nursing home or other institutional settings. This program covers the basics, including room and board and access to medical care when needed. To be eligible, applicants must have an income and assets that fall below state-specific limits.
Key Benefits:
Medicaid Waiver programs are state-run initiatives that provide home and community-based services (HCBS) to seniors who would otherwise require care in a nursing home or other institutional settings. These programs offer a sense of freedom and confidence to seniors, allowing them to receive care in the comfort of their own homes or local communities.
Some Services That May Be Covered:
Key Benefits:
The Aged, Blind, and Disabled (ABD) Medicaid program provides essential healthcare and long-term care services to financially limited residents who are 65 or older, blind, or disabled and living in the community. Unlike general Medicaid, ABD Medicaid is specifically designed for these vulnerable groups.
Some Services That May Be Covered:
Key Benefits:
Age and Residency:
To qualify, you must be a Pennsylvania resident aged 65 or older and meet the state’s criteria for a Nursing Facility Level of Care, even if they are applying for Assisted Living or Home Care services.
Income Limits:
Asset Limits:
Countable vs. Non-Countable Assets:
Retirement accounts: 401(k) and IRA Accounts:
The treatment of retirement accounts in long-term care Medicaid eligibility varies by state. In some states, retirement accounts like IRAs and 401(k)s are counted as assets for both the applicant and their spouse, while other states may only count them for the applicant. In many cases, if the accounts are in payout status (i.e., the individual is taking required minimum distributions), only the income from the distributions is counted, and the principal may be exempt. However, a few states exempt retirement accounts for both the applicant and the spouse, regardless of whether they are in payout status. Since rules differ significantly across states, it is essential to consult state-specific Medicaid guidelines or a professional Medicaid planner.
Home Equity Limit:
Home Exemption Note: If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest and regardless of where the applicant lives.
Community Spouse Resource Allowance (CSRA). The CSRA is designed to prevent the impoverishment of the community spouse by allowing them to keep a portion of the couple’s resources. In Pennsylvania the CSRA works by evaluating the couple’s combined countable assets and then splitting them in half. The community spouse is then allowed to keep up to a maximum of $154,140.00 and a minimum of $30,828.00 if half falls below that.
Community Spouse Resource Allowance (CSRA): The non-applicant spouse (community spouse) can retain up to $154,140.00 in assets.
Minimum Monthly Maintenance Needs Allowance (MMMNA): This is the minimum amount of income the community spouse is allowed to retain, which in 2024 ranges from $2,465.00 to $3,853.50 per month, depending on housing costs. This ensures the community spouse has sufficient income to meet their living expenses.
Nursing Home Residents: Pennsylvania Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They keep a “personal needs allowance” (PNA).
PNA in Pennsylvania: $45.00
Pennsylvania has a 5-year look-back period. Any asset transfers for less than fair market value during this period may result in a penalty period of ineligibility.
The transfer penalty is a rule in Medicaid planning that applies when someone gives away or transfers assets for less than fair market value within a certain period before applying for long-term care Medicaid. This period is called the look-back period, which is typically 60 months (5 years) in most states. If any such transfers are found during the look-back period, Medicaid may impose a penalty, which delays the applicant’s eligibility for Medicaid benefits.
Example:
Let’s say an individual applies for Medicaid and is found to have transferred $50,000 to their child two years before applying. In their state, the average monthly cost of nursing home care is $10,000. To calculate the penalty, the amount transferred ($50,000) is divided by the average monthly cost of care ($10,000), resulting in a 5-month penalty period. During this 5-month period, Medicaid will not cover the individual’s nursing home costs, and they will need to pay out of pocket.
The penalty starts only when the person is otherwise eligible for Medicaid (in terms of income and assets) and has applied for Medicaid, so it’s crucial to time any transfers carefully when planning for long-term care.
Per Day: $379.65 Per Month: $11,547.69
NOTE: The U.S. Federal Gift Tax Rule does affect Medicaid eligibility. In 2024, individuals can gift up to $18,000 per recipient without filing a Gift Tax Return. However, gifting under this rule still violates Medicaid’s Look-Back Period, which may result in penalties when applying for Medicaid.
Definition: Estate recovery refers to the process by which Medicaid seeks reimbursement for long-term care costs from the estates of deceased beneficiaries. In Pennsylvania, the state has not expanded the definition of “estate” beyond those assets that go through probate, meaning that Medicaid can only recover from assets that are part of the probate estate. Hardship Provision: In Pennsylvania, an exception is built into the estate recovery plan. This provision kicks in when seeking to recoup costs from an estate would cause serious financial strain on the family left behind.
Implementation: Yes, Pennsylvania has implemented a Long-Term Care Partnership program. This program allows individuals who purchase qualifying long-term care insurance policies to protect a portion of their assets equal to the amount of benefits paid out by the policy if they later need to apply for Medicaid.
Medicaid provides coverage for nursing home care for individuals who medically require a Nursing Home Level of Care and meet the necessary financial criteria. In addition to nursing home care, Medicaid also offers programs for seniors who may need nursing home-level care but prefer to stay at home or in a community-based setting. These programs provide essential care and support services that allow individuals to remain independent while receiving the necessary assistance to meet their health and daily living needs. This ensures a comprehensive approach to long-term care that includes options beyond institutional settings.
The Community HealthChoices (CHC) Program is Pennsylvania’s Medicaid managed care program designed to improve and coordinate care for individuals who are eligible for both Medicare and Medicaid (dual-eligible) and for those receiving long-term services and supports (LTSS) in the community.
Program Benefits:
Medical care Personal assistance Support for daily living activities Help participants live independently in their homes and communities
Goals:
Services My Way is a participant-directed option within Pennsylvania’s Medicaid program that allows individuals greater control over their long-term care services and supports.
Program Benefits:
Goals:
The Living Independence for the Elderly (LIFE) Program in Pennsylvania is a comprehensive, managed care program that helps older adults live independently while receiving the medical, social, and personal care services they need.
Program Benefits:
Goals:
The Money Follows the Person (MFP) Program in Pennsylvania is a federally funded initiative designed to help individuals transition from institutional settings, such as nursing homes, back into their homes or community-based settings.
Program Benefits:
Goals:
Applying for Pennsylvania Medicaid involves several steps to ensure you meet the eligibility requirements and submit the necessary documentation. Here’s how you can apply:
Pennsylvania residents looking for nursing homes can use the Pennsylvania Department of Health Nursing Care Facility Locator, which features an interactive map to help locate facilities within the state. Additionally, the Nursing Home Compare tool, managed by the Centers for Medicare & Medicaid Services (CMS), provides detailed information on nursing homes nationwide, allowing for easy comparison across various care options.
The Pennsylvania Domiciliary Care (Dom Care) Program provides a safe and supportive living environment for adults who cannot live independently due to physical, intellectual, or developmental disabilities, or due to aging. This program offers an alternative to institutional care by placing eligible individuals in private homes with certified caregivers. Caregivers provide assistance with daily activities, personal care, medication management, and companionship, fostering a family-like atmosphere.
Goals and Objectives
The Pennsylvania Options Program, also known as the Options Program, provides a range of in-home and community-based services to help older adults and adults with disabilities live independently in their own homes. Administered by local Area Agencies on Aging (AAAs), the program offers services such as:
Goals and Objectives
The Pennsylvania Assistive Technology Foundation (PATF) is a non-profit organization dedicated to helping individuals with disabilities and older adults acquire assistive technology devices and services. PATF provides:
Assistive Technology
Goals and Objectives
The Low-Income Home Energy Assistance Program (LIHEAP) is a federally funded initiative that helps low-income households in Pennsylvania cover the costs of home heating and energy bills. LIHEAP provides:
Goals and Objectives
For more detailed information on these topics, please visit the following pages:
For personalized assistance or more detailed information, you can contact the Pennsylvania Department of Human Services at PA DHS Contact Information.