Pennsylvania Medicaid Nursing Home Eligibility: A Complete Guide

Pennsylvania families facing nursing home costs averaging $115,000–$130,000 per year often turn to Medical Assistance (Pennsylvania's Medicaid program) to cover long-term care. Pennsylvania has several distinctive features compared to other states, including a higher asset limit.

Who Qualifies

1. Medical necessity — Physician certifies need for nursing facility level of care.
2. Financial eligibility — Income and asset limits.
3. Pennsylvania residency — U.S. citizenship or qualifying immigration status.

Income Requirements

• Monthly income limit: $2,829/month (300% of SSI, 2025)

Community spouse income protections: Monthly Maintenance Needs Allowance up to approximately $3,715/month.

Asset Requirements

Pennsylvania has a higher asset limit than most states:

• Single individual: $8,000 in countable assets
• Community spouse: Up to $148,620 (2025 CSRA)

Exempt assets: Primary home, one vehicle, personal property and household goods, irrevocable prepaid burial arrangements.

Look-back period: Pennsylvania enforces a 60-month (5-year) look-back period.

Application Process

Apply through your County Assistance Office (CAO) under the Pennsylvania Department of Human Services (DHS):

1. Find your local CAO at dhs.pa.gov or call 1-800-692-7462.
2. Request Long-Term Care application form PA 600 L.
3. Submit: income records, 60 months of bank statements, property records, physician certification.

Retroactive coverage up to 3 months prior may be available.

What Pennsylvania Medicaid Covers

Covered: Semi-private room and board, skilled and custodial nursing care, physical/occupational/speech therapy, physician and specialist visits, prescriptions, medical equipment.

Not covered: Private rooms (unless medically required), personal comfort items, telephone and TV charges.

Home- and Community-Based Programs

Pennsylvania's Office of Long-Term Living (OLTL) administers:

• Aging Waiver: For adults 60+ requiring nursing facility level of care who prefer to remain at home. Services include personal care, home health, adult day services, and personal emergency response.
• LIFE (Living Independence for the Elderly) / PACE: Comprehensive coordinated care in participating regions.
• OBRA Waiver: Supports adults under 60 with physical disabilities in community settings.

Contact your local Area Agency on Aging at aging.pa.gov.

Frequently Asked Questions

Why is Pennsylvania's asset limit $8,000 instead of $2,000?

Pennsylvania state law sets its asset limit higher than the federal minimum, allowing applicants to retain more in savings.

Is my car protected?

One vehicle of any value is exempt, regardless of market value.

How do I find my County Assistance Office?

Visit compass.state.pa.us or call 1-800-692-7462.