Long-Term Care Costs in Pennsylvania

Pennsylvania has long-term care costs that are above national averages in several categories — nursing home care (semi-private) averages $11,954 per month, approximately 25% above the national average of $9,581, while assisted living averages $6,480 per month, approximately 5% above the national average of $6,200. Home care averages $6,483 per month, approximately 3% below the national rate of $6,673. Pennsylvania's Medicaid program is called Medical Assistance (MA), administered by the Pennsylvania Department of Human Services (DHS) through managed care organizations under Community HealthChoices (CHC). Pennsylvania has no income limit for Nursing Home Medicaid — income is not a barrier to eligibility. The asset limit is $2,400 for individuals, which is slightly higher than the $2,000 standard used by most states. Pennsylvania also offers a Medically Needy pathway for applicants whose income exceeds standard thresholds. This guide covers what care costs in Pennsylvania, how to qualify for Medicaid, and what options exist for veterans and family caregivers in Philadelphia, Pittsburgh, Allentown, Harrisburg, Erie, Scranton, and across the Keystone State.

Pennsylvania's Aging Population: The Numbers Behind the Need

Pennsylvania is home to more than 2.4 million residents aged 60 or older — a significant portion of the state's roughly 13 million total population. Pennsylvania has the third highest percentage of elderly residents among all 50 states. The senior population is concentrated in Philadelphia (Philadelphia County — PA's largest city), Pittsburgh (Allegheny County), Allentown (Lehigh County), Harrisburg (Dauphin County — the state capital), Erie (Erie County), Reading (Berks County), Scranton (Lackawanna County), and Lancaster (Lancaster County).

Pennsylvania's geography — from the densely populated Philadelphia and Pittsburgh metros to vast rural areas in central and northern Pennsylvania — creates significant long-term care access challenges. The Philadelphia metro, Pittsburgh, and the Lehigh Valley have the most provider options, while rural northern tier counties, central Pennsylvania, and parts of western PA face provider shortages and limited home care availability.

Unpaid Caregivers in Pennsylvania: Scale and Impact

An estimated 1.5 million unpaid family caregivers in Pennsylvania provide care to aging relatives and adults with disabilities. According to AARP research, family caregivers nationwide spend an average of $7,242 per year in out-of-pocket costs related to caregiving.

Pennsylvania's Community HealthChoices (CHC) program allows participants to hire family members — including adult children — as paid caregivers through the participant-directed model. The Act 150 Attendant Care Program provides state-funded attendant care services for individuals with physical disabilities, offering an alternative for those who do not qualify for Medicaid. Pennsylvania also supports caregivers through the PA Link to Aging and Disability Resources network and Area Agencies on Aging across all 67 counties.

What Long-Term Care Costs in Pennsylvania

Pennsylvania's care costs are above national averages, particularly for nursing home care:

• Assisted Living: $6,480 per month — approximately 5% above the national average of $6,200
• Nursing Home (semi-private room): $11,954 per month — approximately 25% above the national average of $9,581
• Nursing Home (private room): $13,688 per month — approximately 27% above the national average of $10,798
• Home Care (home health aide): $6,483 per month — approximately 3% below the national average of $6,673
• Adult Day Care: $2,535 per month — approximately 23% above the national average of $2,058
• Memory Care: $8,100 per month (estimated)

At these rates, a three-year nursing home stay in Pennsylvania costs approximately $430,000 (semi-private) — while home care totals roughly $233,000 over the same period. Assisted living, at $6,480/month, totals approximately $233,000 over three years. For a detailed breakdown of care costs by type and how Pennsylvania compares to other states, visit our Pennsylvania Care Costs page.

How to Qualify for Pennsylvania Medicaid (Medical Assistance): Eligibility Rules for 2026

Pennsylvania's Medicaid program is called Medical Assistance (MA), administered by the Pennsylvania Department of Human Services (DHS). Long-term care services are delivered through managed care organizations under Community HealthChoices (CHC). In addition to nursing home care, assisted living, and personal care homes, PA Medicaid pays for many non-medical support services that help frail seniors remain living at home. Consulting with a Pennsylvania elder law attorney or Certified Medicaid Planner early can help families avoid costly mistakes. Eligibility rules vary by program type:

• Nursing Home Medicaid (Institutional): There is no income limit — Pennsylvania does not cap income for nursing home Medicaid eligibility. All of a beneficiary's monthly income, aside from a $45/month Personal Needs Allowance, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must be paid to the nursing home (Patient Liability). Asset limit of $2,400 (single) or $4,800 (married couple both applying). When only one spouse applies, the non-applicant spouse may retain up to $162,660 in assets (2026 CSRA). This is an entitlement.
• Medicaid Waivers / Home and Community Based Services (HCBS) via CHC: Income limit of $2,982/month (300% of SSI). Asset limit of $2,400 (single) or $4,800 (couple, both applying). Pennsylvania has a Medically Needy (Spend-Down) pathway for applicants over the income limit. This is not an entitlement — waiting lists may exist for certain services.
• Regular Medicaid / Aged, Blind, and Disabled: Income limit of $994/month (single) or $1,491/month (couple). Asset limit of $2,400 (single) or $3,200 (couple). This is an entitlement.

Pennsylvania applies a 60-month (5-year) look-back period for Nursing Home Medicaid and HCBS Waiver applications. Asset transfers during this period — including gifts to family members — can trigger a penalty period of Medicaid ineligibility. The federal $19,000 Gift Tax Exemption (2026) does NOT apply to Medicaid's look-back rules. The Look-Back Period does not apply to Regular Medicaid. For the full Pennsylvania Medicaid eligibility breakdown, see our Pennsylvania Medicaid Guide.

Spousal Protections and Community Spouse Resource Allowance

When one spouse applies for Nursing Home Medicaid or an HCBS Waiver in Pennsylvania, only the applicant spouse's income is counted. The Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to retain 50% of the couple's assets, up to $162,660 (2026). If the non-applicant's share falls below $32,532, up to $32,532 can be retained.

Pennsylvania sets the Minimum Monthly Maintenance Needs Allowance (MMMNA) at $2,643.75 per month (eff. 7/1/25 – 6/30/26). If the non-applicant spouse's income falls below this amount, income can be transferred from the applicant spouse. The non-applicant spouse can further increase their Spousal Income Allowance if housing/utility costs exceed a shelter standard of $793.13/month (eff. 7/1/25 – 6/30/26), up to a maximum of $4,066.50/month. For Regular Medicaid, both spouses' income is counted and there is no MMMNA or CSRA.

Pennsylvania Medicaid Programs: Community HealthChoices & Waiver Options

Pennsylvania delivers long-term care services primarily through the Community HealthChoices (CHC) managed care system, which replaced the legacy waiver programs. Key programs include:

• Community HealthChoices (CHC): Pennsylvania's mandatory managed long-term services and supports (MLTSS) program. CHC integrates physical health, behavioral health, and long-term services. Participants can receive home and community-based services including personal care, home modifications, adult day services, and assisted living. CHC operates statewide through three managed care organizations (MCOs).
• Participant-Directed Model (CHC): Within CHC, participants can choose a self-directed option to hire their own caregivers, including adult children, manage their care schedule, and direct their services. This gives families flexibility in providing care while receiving compensation.
• OBRA Waiver: Serves adults aged 18–59 with physical disabilities (individuals who entered the waiver before turning 60 may continue past age 59). Provides personal assistance, home modifications, assistive technology, and respite care. Waiting lists may exist.
• Act 150 Attendant Care Program: A state-funded (not Medicaid) program providing attendant care services for individuals aged 18–59 with physical disabilities. Income limits are higher than Medicaid — up to 200% of the Federal Poverty Level. Provides an option for those who do not qualify for Medicaid.
• Program of All-Inclusive Care for the Elderly (PACE): Combines Medicaid and Medicare benefits into a single program for participants aged 55+. Pennsylvania has multiple PACE organizations operating across the state, including in Philadelphia, Pittsburgh, and other regions. Additional benefits such as dental and eye care may be available.
• OPTIONS Program: State-funded program through Area Agencies on Aging for seniors aged 60+ who need home and community-based services but do not qualify for Medicaid. Services include personal care, home-delivered meals, and adult day care. Waiting lists may exist.

Qualifying When Over the Limits: Medically Needy Spend-Down

Pennsylvania has a Medically Needy (Spend-Down) program, which provides an additional pathway to Medicaid eligibility for applicants whose income exceeds standard limits:

• Medically Needy Spend-Down: Applicants with income above Medicaid limits can "spend down" excess income on medical and care expenses until their remaining income falls within eligibility limits. This effectively allows higher-income individuals to qualify for Medicaid-funded long-term care. Since Pennsylvania has no income limit for nursing home Medicaid, the Medically Needy program applies primarily to HCBS waiver applicants.
• Asset Spend-Down: Spend excess assets on non-countable items — home modifications (wheelchair ramps, roll-in showers, stair lifts), vehicle modifications (wheelchair lifts, adaptive controls), prepaying funeral/burial expenses, and paying off debt. Keep documentation as proof Medicaid's look-back rule was not violated.
• Medicaid Planning: Work with a Medicaid Planning Professional to employ legal strategies for eligibility and protect your home from Medicaid's Estate Recovery Program.

Asset Rules: What Counts and What Doesn't

Countable assets in Pennsylvania include cash, stocks, bonds, investments, cryptocurrency, bank accounts (money market, savings, checking), and real estate in which one does not reside. In Pennsylvania, IRAs / 401Ks in payout status are generally not counted as assets — regular periodic distributions are treated as income instead. However, lump-sum withdrawals may be counted as assets. Exempt (non-countable) assets include personal belongings, household furnishings, an automobile, irrevocable burial trusts, term life insurance, and generally one's primary home.

Pennsylvania's asset limit is $2,400 for an individual and $4,800 for a married couple (both applying) for Nursing Home and HCBS Medicaid — higher than the $2,000 standard used by most states. For Regular Medicaid, the limit is $2,400 (single) and $3,200 (couple). All assets of a married couple are considered jointly owned regardless of the Medicaid program. The CSRA allows the non-applicant spouse to retain 50% of assets up to $162,660 (minimum $32,532). There is no CSRA for Regular Medicaid. In Pennsylvania, VA Aid & Attendance does not count as income. Nationally, Holocaust restitution payments are not counted as income.

Veterans and Long-Term Care in Pennsylvania

Pennsylvania has one of the largest veteran populations in the country, with facilities including the Philadelphia VA Medical Center, the VA Pittsburgh Healthcare System (two campuses), the Lebanon VA Medical Center, the Wilkes-Barre VA Medical Center, the Erie VA Medical Center, the Coatesville VA Medical Center, and community-based outpatient clinics across the state. Pennsylvania also operates six state veterans' homes — in Hollidaysburg, Erie, Pittsburgh, Scranton, Spring City, and Philadelphia.

Pennsylvania does not count VA Aid & Attendance as income for Medicaid eligibility purposes. Veterans should factor this advantage into their long-term care planning strategy. For a comprehensive overview of veteran long-term care benefits, see our Veterans Long-Term Care Guide.

Planning Ahead: How to Pay for Nursing Home Care in Pennsylvania

Understanding how to pay for nursing home care in Pennsylvania — or any long-term care setting — requires evaluating multiple funding sources. With nursing home costs at $11,954/month (25% above the national average), a 60-month look-back period, and a $2,400 asset limit, advance planning is critical. Pennsylvania long-term care insurance policies, personal savings, veterans benefits, and Medicaid each play a role. Key steps include:

• Understanding your current financial position relative to Pennsylvania's Medicaid eligibility thresholds
• Knowing that Pennsylvania has no income limit for nursing home Medicaid — income is not a barrier to eligibility
• Leveraging the Medically Needy (Spend-Down) program for HCBS waiver applicants over the $2,982 income limit
• Leveraging Pennsylvania's MMMNA ($2,643.75) and the shelter cost exception (up to $4,066.50) to protect the non-applicant spouse's income
• Exploring Community HealthChoices (CHC) participant-directed services to hire adult children as paid caregivers
• Recognizing that Pennsylvania's $2,400 asset limit is slightly higher than the $2,000 standard used by most states
• Recognizing that IRAs/401Ks in payout status are generally treated as income, not assets, in Pennsylvania
• Recognizing that Pennsylvania does not count VA Aid & Attendance as income
• Exploring PACE programs, especially in the Philadelphia and Pittsburgh metros
• Consulting with a Pennsylvania elder law attorney or Certified Medicaid Planner to protect assets and avoid look-back penalties

Estate Recovery: Protecting Your Home in Pennsylvania

Pennsylvania operates a Medicaid Estate Recovery Program (MERP), which allows the state to seek reimbursement from a deceased Medicaid beneficiary's estate for long-term care costs paid by Medicaid. This can include the family home if proper protections are not in place. The primary home is automatically exempt if the applicant's spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.

If no qualifying family member lives in the home, there is a home equity interest limit of $730,000 (in 2026). If neither the applicant nor qualifying family live in the home, the applicant must demonstrate Intent to Return. There is no home equity interest limit for Regular Medicaid. The home is NOT exempt from estate recovery — families should consult a Pennsylvania elder law attorney to explore legal protections such as Medicaid Asset Protection Trusts and Lady Bird Deeds (Transfer on Death Deeds).

Regional Cost Variations Across Pennsylvania

Long-term care costs in Pennsylvania vary significantly by region. The Philadelphia metro (Philadelphia, Montgomery, Delaware, Chester, and Bucks Counties) typically sees the highest costs due to higher demand and cost of living. Pittsburgh (Allegheny County) represents mid-to-upper range costs. The Lehigh Valley (Allentown, Bethlehem, Easton) has seen rising costs driven by population growth and proximity to the New York metro. Harrisburg, Lancaster, and York generally have moderate costs. Rural northern tier counties — including Bradford, Tioga, Potter, and Sullivan — generally have lower costs but significantly fewer providers and limited home care availability.

Application Timeline and Process

Pennsylvania Medical Assistance (Medicaid) applications can be submitted through several channels:

• Apply online at COMPASS (compass.state.pa.us)
• Apply in-person at a local County Assistance Office (CAO)
• Call the PA DHS Helpline at 1-800-692-7462
• Contact the local Area Agency on Aging for questions and application assistance — PA has 52 AAAs covering all 67 counties
• Call PA Link to Aging and Disability Resources at 1-800-753-8827

Applicants must be certain all eligibility criteria are met prior to submitting a Medicaid application. Persons with excess income and/or assets should strongly consider Medicaid Planning. The application process can be lengthy and specific documentation must be included. Processing times vary but typically take 45–90 days.

Federal Policy Update: One Big Beautiful Bill Act (OBBBA)

The One Big Beautiful Bill Act (OBBBA) includes approximately $1 trillion in Medicaid cuts over 10 years. While Nursing Home Medicaid is largely protected from future funding reductions, Home and Community Based Services (HCBS) — including Pennsylvania's Community HealthChoices (CHC), OBRA Waiver, Act 150, OPTIONS, and PACE — are likely targets for cuts. This law is still facing legal challenges. Families relying on or planning to use HCBS should monitor developments and consider applying early.

Last updated: September 2026. Data sources: Pennsylvania Department of Human Services, CareScout 2025 care cost survey (updated March 2026). All Medicaid figures reflect 2026 eligibility thresholds. This guide is for informational purposes only and does not constitute legal or financial advice.