Medicaid Long-Term Care Guide in Pennsylvania

Long-term care eligibility, benefits, and how to apply through the Pennsylvania Department of Human Services.

What makes Pennsylvania Medicaid different

Medicaid in Pennsylvania is called Medical Assistance (MA). Jointly funded by the state and federal government, it is administered by the state. The Department of Human Services is the administering agency. In addition to nursing home care and assisted living, PA Medicaid pays for non-medical support services to help frail seniors live at home or in the home of a loved one.

Administered by the Pennsylvania Department of Human Services.

Program Types

Entitlement

Institutional / Nursing Home Medicaid

An entitlement; anyone who is eligible will receive assistance. Benefits are provided in Medicaid-certified nursing homes.

Level of care: Nursing Home

Limited Slots

Medicaid Waivers / Home and Community Based Services (HCBS)

Not an entitlement; there are a limited number of participants and waiting lists may exist. Intended to prevent and delay nursing home admissions, services are provided at home, adult day care, or in assisted living.

Level of care: Nursing Home

Entitlement

Regular Medicaid / Aged, Blind, and Disabled

An entitlement; meeting the eligibility requirements ensures one will receive assistance. While Regular Medicaid is not Long-Term Care Medicaid, some long-term care services, such as personal care assistance or adult day care, may be available.

Level of care: Help with ADLs

2026 Pennsylvania Medicaid Long-Term Care Eligibility for Seniors

Institutional / Nursing Home Medicaid^*

Single

Income$2,982 / month*Assets$2,000‡Care LevelNursing Home

Married (Both)

Income$5,964 / month ($2,982 per spouse)*Assets$4,000 ($2,000 per spouse)‡Care LevelNursing Home

Married (One)

Income$2,982 / month for applicant*Assets$2,000 for applicant & $162,660 for non-applicant‡Care LevelNursing Home

Medicaid Waivers / Home and Community Based Services^†

Single

Income$2,982 / month†Assets$2,000‡Care LevelNursing Home

Married (Both)

Income$5,964 / month ($2,982 per spouse)†Assets$4,000 ($2,000 per spouse)‡Care LevelNursing Home

Married (One)

Income$2,982 / month for applicant†Assets$2,000 for applicant & $162,660 for non-applicant‡Care LevelNursing Home

Regular Medicaid / Aged, Blind, and Disabled

Single

Income$1,016.10 / monthAssets$2,000Care LevelHelp with ADLs

Married (Both)

Income$1,524.30 / monthAssets$3,000Care LevelHelp with ADLs

Married (One)

Income$1,524.30 / monthAssets$3,000Care LevelHelp with ADLs

^*All of a beneficiary's monthly income, with the exception of a Personal Needs Allowance of $60 / month, Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, must go towards nursing home costs. This is called a Patient Liability.

^†Based on one's living setting, a beneficiary may not be able to keep monthly income up to this level.

^‡Pennsylvania allows an extra $6,000 exemption in addition to the asset limits listed. Exception: If an applicant has income over $2,982 / month, the total asset limit is $2,400 (no $6,000 disregard).

Explore Pennsylvania Medicaid Programs

Compare programs, see caregiver pay rates, get step-by-step application guidance, and check your eligibility — all specific to Pennsylvania.

Long-term care Medicaid guide

Eligibility · Caregiver pay · How to apply · 2026 data

Important: Rates vary — contact your state Medicaid office for current figures. This tool provides general guidance, not legal or financial advice.

Compare Medicaid Programs — Pennsylvania

How the main LTC programs available in Pennsylvania compare side by side.

Pennsylvania does not have a general Structured Family Caregiving program. Consumer-directed hourly pay is the primary Medicaid option for family caregivers.

Program	Pay	Pay type	Tax-free?	Spouse OK?	Waitlist?
Consumer-directed HCBS	$15–18/hr	Hourly wage	No	Usually no	Often
Structured Family Caregiving (SFC)	Not in Pennsylvania	Daily stipend	Yes	Usually no	Often
Personal Care Agreement	Market rate (from assets)	Private pay	No	Yes	No
VA Aid & Attendance	Up to $2,874/mo	Monthly pension	Yes	Yes	No

Pennsylvania Medicaid programs

COMMCARE Waiver

Independence Waiver

CarePlus SFC (UPMC only — not statewide)

2026 policy warning: The One Big Beautiful Bill Act (signed July 4, 2025) cuts federal Medicaid spending by ~$911 billion over 10 years. HCBS waiver waitlists are expected to grow significantly. Apply as early as possible — do not wait for a crisis.

Sources: KFF (Jan 2026), medicaidplanningassistance.org (Feb 2026). Programs and rates change — verify with your state Medicaid office.

How to Apply for Medicaid Long-Term Care in Pennsylvania

What to expect when applying for LTC Medicaid and getting family caregiver pay set up in Pennsylvania. The process typically takes 45–90 days from application to first paycheck.

Gather financial documents

You'll need: Social Security or Medicare card, 3 months of bank statements, most recent tax return, pension or benefit award letters, property deed(s), vehicle title(s). Having these ready speeds up the application by weeks.

Consider a Medicaid planning consultation

An elder law attorney or Certified Medicaid Planner (CMP) can review your finances before you apply — especially if income or assets are over the limit. Many families save thousands by planning first. Find one at elderlawanswers.com or medicaidplanners.org.

Get a physician's statement of care needs

LTC Medicaid requires documentation that the person needs a nursing facility level of care (NFLOC). Your doctor fills out a form confirming they need help with 3+ ADLs or have a qualifying condition. Ask for this before or during the application.

Submit the application — Pennsylvania

Where to apply: DHS · dhs.pa.gov. Most states accept applications online, by mail, or in person. You can usually apply by phone too. The application covers both financial information and care needs.

Level of care assessment

After the financial review, a nurse or social worker will assess the person's care needs and confirm NFLOC. This is required for all HCBS programs. Be honest about the worst days, not the best.

Program enrollment and fiscal intermediary

Once approved for a self-directed HCBS or SFC program, you'll be assigned to a fiscal intermediary — a company that handles payroll, taxes, and compliance on your behalf. Examples: Public Partnerships LLC (PPL), FreedomCare, Careforth — depending on which programs are available in Pennsylvania.

Caregiver begins getting paid

Once the fiscal intermediary is set up, the caregiver is added to payroll. SFC programs typically pay twice per month. Consumer-directed programs pay weekly or biweekly. You'll receive a W-2.

5-year lookback warning: Medicaid reviews every asset transfer made in the 60 months before application. Gifts, transfers to family, or selling assets below market value can trigger a penalty period. Do not transfer assets without professional guidance first.

Don't wait for a crisis. HCBS waitlists in Pennsylvania can be long — sometimes 1–2 years. Apply now, even if care hasn't started yet.

Apply in Pennsylvania: DHS · dhs.pa.gov

Medicaid Eligibility Screener — Pennsylvania

Answer 7 quick questions — we'll check the financial and care requirements for Pennsylvania and explain what each one means.

What is the marital status of the person who needs care?

Medicaid looks at only the applicant's income and assets — but being married triggers special protections that let the healthy spouse keep significantly more money.

Sources

CMS Medicaid — eligibility, HCBS waivers, and long-term services medicaid.gov/medicaid/eligibility
CMS Medicaid — Home & Community-Based Services (HCBS) medicaid.gov/medicaid/home-community-based-services
Social Security Administration — SSI Federal Benefit Rate (2026 figures) ssa.gov/oact/cola/SSI.html
CMS — Spousal Impoverishment standards (CSRA & MMMNA) medicaid.gov/medicaid/eligibility/spousal-impoverishment
CMS — Estate Recovery and the 5-year lookback period medicaid.gov/medicaid/eligibility/estate-recovery
IRS Notice 2014-7 — Tax treatment of Medicaid caregiver payments irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income

Educational guidance only — not legal or financial advice. Your state Medicaid office determines actual eligibility.

View Full Pennsylvania Medicaid Guide →Compare Medicaid Eligibility Across All States →

Key Rules at a Glance

Nearly any income from any source is counted towards Medicaid's income limit, including employment wages, alimony, pension payments, SSDI, SSI, IRA withdrawals, and stock dividends.
Nationally, Holocaust restitution payments are not counted as income.
In PA, VA Aid & Attendance or Housebound payments, which are above and beyond the Basic VA Pension, do not count.
When only one spouse applies for Nursing Home Medicaid or a Waiver, only the applicant's income is counted.
The MMMNA (called CSMMNA in PA) is $2,644 (eff. 7/1/25 – 6/30/26). If a non-applicant spouse's income is under this amount, income can be transferred from the applicant spouse.
The non-applicant spouse can further increase their Spousal Income Allowance if housing and utility costs exceed a 'shelter standard' of $794 / month (eff. 7/1/25 – 6/30/26). The maximum allowance is $4,066.50 / month in 2026.
For Regular Medicaid, both spouses' income is counted. There is no Spousal Income Allowance for a non-applicant spouse.

Countable assets include stocks, bonds, investments, cryptocurrency, and bank accounts (money market, savings, checking).
In Pennsylvania, the applicant's IRA / 401K is counted. However, the IRA / 401K of a non-applicant spouse is exempt.
Exempt (non-countable) assets include personal belongings, household items, a vehicle, irrevocable burial reserves (up to 25% of average burial cost in one's area), and generally one's primary home.
Pennsylvania allows an extra $6,000 asset disregard for Nursing Home Medicaid and Waivers. If income exceeds $2,982 / month, the total asset limit is $2,400 instead.
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 the couple's assets, up to $162,660 (2026). If the non-applicant's half is under $32,532, up to $32,532 can be retained.
There is no CSRA for Regular Medicaid.

The 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 this is not the case, there is a home equity interest limit of $730,000 (in 2026).
Home equity is the value of the home minus any outstanding debt. Equity interest is the amount of equity owned by the applicant.
If neither the applicant nor qualifying family live in the home, the applicant must have Intent to Return.
There is no home equity interest limit for Regular Medicaid.
The home is NOT exempt from Medicaid's Estate Recovery Program. After a beneficiary's death, Pennsylvania's Medicaid agency attempts reimbursement of care costs through the deceased's estate.

Pennsylvania has a 5-year (60-month) Medicaid Look-Back Period for Nursing Home Medicaid and Medicaid Waiver applications.
Medicaid checks all asset transfers, including those by a non-applicant spouse, to ensure none were gifted or sold under fair market value.
Violations result in a Penalty Period of Medicaid ineligibility.
The Look-Back Period does not apply to Regular Medicaid.
The U.S. Federal Gift Tax Rule ($19,000 per recipient in 2026) does not extend to Medicaid eligibility — gifting under this rule violates Medicaid's Look-Back Period.

MMMNA: $2,644 · CSRA: $162,660 · CSRA Min: $32,532
When only one spouse applies for Nursing Home Medicaid or a Waiver, only the applicant's income is counted.
The MMMNA (CSMMNA in PA) is $2,644 (eff. 7/1/25 – 6/30/26). Income can be transferred from the applicant spouse if the non-applicant's income is below this level.
The non-applicant spouse can increase their allowance if housing/utility costs exceed $794 / month, up to a maximum of $4,066.50 / month in 2026.
The CSRA (called the 'protected share' in PA) allows the non-applicant spouse to retain 50% of assets up to $162,660 (min $32,532) in 2026.
For Regular Medicaid, both spouses' income is counted and there is no MMMNA or CSRA.

Medically Needy Pathway — Pennsylvania has a Medically Needy Only Medical Assistance (MNO-MA) program. Persons over the income limit can become eligible by spending income on medical expenses, including nursing home bills. The MNIL is $425 / month for an individual and $442 / month for a couple (2026). The 'spend down' is calculated for a 6-month period. Once met, one is income-eligible for the remainder of the period. The MNO-MA asset limits are $2,400 (individual) and $3,200 (couple) with no additional disregard.
Asset Spend-Down — Spend excess assets on non-countable items such as home modifications (wheelchair ramps, stair lifts), prepaying funeral/burial expenses, and paying off debt. Keep documentation as proof the Look-Back Rule was not violated.
Medicaid Planning — Work with a Medicaid Planning Professional to employ strategies to become eligible and protect your home from Medicaid's Estate Recovery Program.

Pennsylvania does not use Qualified Income Trusts (Miller Trusts). The Medically Needy / MNO-MA program is available for persons over the income limit. Pennsylvania also offers a unique $6,000 asset disregard for LTC Medicaid applicants with income under $2,982 / month.

Pennsylvania Medicaid Programs

Community HealthChoices (CHC) Program

A Medicaid managed care program for state residents who are aged or physically disabled. The previously available PDA Waiver transitioned into this program. Benefits may include adult day care, personal care assistance, home modifications, and home health services. A program option, Services My Way (SMW), allows self-directed care, including hiring family members such as adult children.

Wait List

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

Combines the benefits of Medicaid, including long-term care, and Medicare into a single program. Additional benefits, such as dental and eye care, may be available.

Money Follows the Person

This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.

How to Apply

Apply online at COMPASS
Fill out a paper application and submit to the local County Assistance Office (CAO)
Apply in person at the local CAO
Call the Health Care Coverage Consumer Service Center at 866-550-4355
Contact the local Area Agency on Aging for questions and application assistance

Applicants must be certain all eligibility requirements are met prior to submitting a Medical Assistance application. Persons over the income and/or asset limits should strongly consider Medicaid Planning. The application process can be lengthy and documentation must be included.

More Pennsylvania Long-Term Care Resources

Pennsylvania Long-Term Care Costs

Compare assisted living, home care, and nursing home costs.

Pennsylvania Senior Services Directory

Find local aging agencies, support programs, and community resources.

Veterans Long-Term Care Benefits

Aid & Attendance, caregiver programs, and VA nursing home coverage.

Take the Next Step for Pennsylvania Medicaid

Find out if you qualify or see how Medicaid fits into your overall long-term care plan.

Sources & references

Verified May 2026

Centers for Medicare & Medicaid Services — Long-Term Services & Supports
Administration for Community Living — State Medicaid Agencies
Centers for Medicare & Medicaid Services — Medicaid Eligibility
American Council on Aging — About Medicaid Planning Assistance
Pennsylvania Department of Human Services — Pennsylvania Medicaid — Official site

Important notes

One Big Beautiful Bill Act (OBBBA) & Medicaid Cuts: Don't panic yet. OBBBA's $1 trillion in Medicaid cuts will happen over 10 years. While Nursing Home Medicaid is largely protected from future funding cuts, Home and Community Based Services (HCBS) are likely to be targeted. This law is still facing legal challenges.

Medicaid Long-Term Care Guide in Pennsylvania

What makes Pennsylvania Medicaid different

Program Types

Institutional / Nursing Home Medicaid

Medicaid Waivers / Home and Community Based Services (HCBS)

Regular Medicaid / Aged, Blind, and Disabled

2026 Pennsylvania Medicaid Long-Term Care Eligibility for Seniors

Institutional / Nursing Home Medicaid*

Medicaid Waivers / Home and Community Based Services†

Regular Medicaid / Aged, Blind, and Disabled

Explore Pennsylvania Medicaid Programs

Long-term care Medicaid guide

Compare Medicaid Programs — Pennsylvania

How Family Caregivers Get Paid Through Medicaid in Pennsylvania

How to Apply for Medicaid Long-Term Care in Pennsylvania

Medicaid Eligibility Screener — Pennsylvania

Key Rules at a Glance

Pennsylvania Medicaid Programs

Community HealthChoices (CHC) Program

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

Money Follows the Person

How to Apply

More Pennsylvania Long-Term Care Resources

Take the Next Step for Pennsylvania Medicaid

Important notes

Institutional / Nursing Home Medicaid^*

Medicaid Waivers / Home and Community Based Services^†