Medicaid for nursing home and home care in Pennsylvania

Who qualifies

You must live in Pennsylvania, be a U.S. citizen or qualified non-citizen, and have a Social Security number. A doctor fills out a form about your medical needs. An agent approved by the Department of Human Services (DHS) reviews it and tells your county assistance office whether you need long-term care.

Then you must meet the money rules. These are the 2026 figures:

If your income is over the limit

Pennsylvania does not require a special trust. Instead, it uses its medically needy rules. The expected cost of nursing home care for six months is treated as a medical bill and taken off your income. If what is left is under the medically needy limit of $2,550 for six months, you can qualify. The resource limit for this group is lower: $2,400.

What counts and what does not

Resources that count:

• Bank accounts
• Stocks, bonds and mutual funds
• IRA and Keogh retirement accounts
• Property other than your home
• Cash value of life insurance, if the face value of all your policies is over $1,500 per person (the first $1,000 of cash value is not counted)

Resources that do not count:

• Your home, if its equity is $752,000 or less and you live there or plan to return, or if your spouse or a dependent lives there.
• One motor vehicle.
• Burial spaces and plots, including a marker.
• Burial reserves, revocable or irrevocable, up to set limits.

Gifts and transfers. DHS looks back 60 months before you enter a nursing home or are assessed for home care and apply. If you gave away money or property for less than it was worth, DHS will not pay for long-term care for a period of time. The penalty is the value given away divided by the average daily private-pay cost of care. It starts when you would otherwise be eligible.

If your spouse stays at home

• Resources. The spouse at home keeps a "spousal share" of half of the couple's countable resources, at least $32,532 and no more than $162,660. These figures change each year. The couple should file a Resource Assessment (form PA 1572) when one spouse enters a nursing home or is found eligible for home care.
• Income. The spouse at home keeps all of their own income. It does not count for the spouse who needs care.
• Monthly allowance. The county assistance office figures a monthly maintenance allowance for the spouse at home, based on that spouse's income and housing costs. Your income is used first to bring the spouse up to that amount. If that is not enough, extra resources can be kept to produce income.
• Hardship. If the spouse at home faces serious money problems, they can ask for a higher allowance through a fair hearing.

What Medical Assistance pays for

Nursing home care

MA pays the difference between the nursing home's charge and the amount you pay each month from your income toward your care.

Care at home: Community HealthChoices (CHC)

CHC is Pennsylvania's managed care program for adults 21 and over who have both Medicare and MA, or who get long-term services because they need help with everyday personal tasks. It covers people in waiver programs and people in Medicaid-paid nursing homes. It can pay for home and community-based services so you can stay at home.

LIFE (Living Independence for the Elderly)

Pennsylvania's name for the federal PACE care program. If you are 55 or older, need nursing-home level care, live in an area a LIFE provider serves and can be safely cared for at home, you can choose LIFE instead of CHC. It covers doctors, drugs, day center care, home care and rides.

Nursing Home Transition

Help moving from a nursing home back to your home or another setting you choose.

How to apply

1. Start the financial application. Apply online on COMPASS (compass.dhs.pa.gov), or fill out the DHS Medicaid long-term care application and mail or take it to your county assistance office. The county office decides financial eligibility.
2. For home care, also call the Independent Enrollment Broker at 1-877-550-4227 (TTY 1-877-824-9346). It handles enrollment in home and community-based services.
3. Get the medical form done. Your doctor fills out the form on your medical needs.
4. If you are married, file the Resource Assessment (PA 1572).

Have records of: income for you and your spouse, bank and investment accounts, retirement accounts, life insurance policies, burial arrangements, your home and any other property, your vehicle, and any gifts or transfers in the past 60 months.

After you apply

• Your monthly share. Once approved in a nursing home, you pay part of your income toward your care. MA pays the rest.
• Report changes in income, resources or address to your county assistance office.
• Appeals. If you are denied, your notice explains how to ask for a fair hearing and the deadline. Ask in writing before that date.
• Estate recovery. After you die, Pennsylvania may seek repayment from your estate for long-term care paid after age 55. Hardship waivers exist. Estate Recovery Program: 800-528-3708.

Common mistakes

• Thinking high income rules you out. Pennsylvania takes the expected cost of nursing home care off your income.
• Moving money in the 60 months before applying. It can cause a penalty period.
• Not filing the PA 1572 when a spouse enters care. DHS uses it to work out the spousal share.
• Forgetting that retirement accounts count. IRAs and Keoghs are counted resources.

Free help

• PA Link to Aging and Disability Resources: 1-800-753-8827
• Independent Enrollment Broker: 1-877-550-4227
• CHC Participant Call Center: 1-800-757-5042
• Area Agency on Aging: call the Department of Aging at 717-783-1550
• PA MEDI (free Medicare counseling): 1-800-783-7067

See also paying for a nursing home, Medicare and all benefits in Pennsylvania.

Phone numbers: Free help lines for Pennsylvania agencies

Check what you may qualify for