Pennsylvania Nursing Home Medicaid pays for a nursing home once Medicare’s short rehabilitation benefit runs out — but only after the family clears an income test, an asset test and a level-of-care assessment. This Pennsylvania nursing home medicaid guide gives the 2026 figures, what the spouse at home is allowed to keep, how the five-year look-back works, and where in Pennsylvania the application actually goes.
Every dollar figure below comes from the state Medicaid agency, CMS or the statute cited, and each resets on its own calendar. Where Pennsylvania has not published a current figure we say so instead of guessing.
In This Pennsylvania Nursing Home Medicaid Guide:
Pennsylvania Nursing Home Medicaid at a Glance (2026)
| Program | Pennsylvania does not use a separate brand name for nursing home Medicaid. The state calls its Medicaid program Medical Assistance (MA), and nursing home coverage is described by the Department of Human Services as Medical Assistance long-term care, or nursing facility services. Once approved, most residents receive their care through Community HealthChoices (CHC), the state’s mandatory managed long-term services and supports program overseen by the DHS Office of Long-Term Living, so families will hear both “Medical Assistance” and “Community HealthChoices” used about the same coverage. |
| 2026 income limit (single applicant) | $2,982 |
| 2026 asset limit (single applicant) | $8,000 ($2,000 + $6,000 disregard) when income is at or below $2,982/month; $2,400 when income is above it |
| Spouse at home may keep (assets) | $32,532 to $162,660 |
| Spouse at home income floor | $2,705 to $4,066.50 per month |
| Look-back period | 60 months |
| Penalty divisor | $421.20/day (applications filed in 2026) |
| Home equity limit (no spouse at home) | $752,000 (confirm with The financial application is taken by your local County Assistance Office (CAO), which is the Department of Human Services office serving the county where your relative lives. You can also apply or send documents through the DHS Statewide Customer Service Center at 1-877-395-8930, or 215-560-7226 for Philadelphia residents. Nursing facility social workers commonly help families assemble and submit the packet, but the CAO is the office that actually decides financial eligibility and issues the written notice.) |
| Over the income limit? | Medically-needy spend-down — no Miller trust |
Pennsylvania Nursing Home Medicaid Income and Asset Limits
Two tests, both applied to the person entering the facility. The income test looks at gross monthly income from every source — Social Security, pensions, IRA withdrawals, annuities, rent. The asset test counts what can be turned into cash: bank accounts, investments, retirement accounts in most states, and any property other than the home.
Pennsylvania is a medically-needy state. Being over the Pennsylvania nursing home medicaid income figure does not end the application: the excess is spent down on the cost of care each month, and the nursing home bill itself usually absorbs it. No Miller trust is needed.
Pennsylvania does not count the primary residence in the ordinary case, and the protection is broader when a spouse, or in some cases a dependent relative, still lives there; a single applicant’s home is protected only up to an equity ceiling this file does not state. One motor vehicle is excluded. So are household goods, furniture and personal effects such as clothing, a wedding ring and other jewelry.
Burial spaces and plots for immediate family are excluded, as is a properly established irrevocable burial reserve or prepaid funeral within state limits.
Pennsylvania does not require a qualified income trust, Miller trust or income-cap trust for nursing facility applicants. It is a medically needy state, so an applicant whose income is above the special income level can still qualify by spending down through the Medically Needy Only pathway, measured over a six-month period rather than month to month. Incurred medical bills, including the private-pay nursing home charge, are applied against income.
After approval, most of the resident’s monthly income goes to the facility as the patient pay liability, with limited deductions.
What the Spouse at Home Keeps Under Pennsylvania Nursing Home Medicaid
Federal spousal impoverishment rules stop Pennsylvania nursing home medicaid from bankrupting the husband or wife who stays home. The at-home spouse keeps a protected share of the couple’s assets — between $32,532 and $162,660 in 2026 — and is guaranteed a monthly income floor of at least $2,705, rising to $4,066.50 when housing costs are high. The house is fully exempt while the spouse lives in it.
Pennsylvania applies the federal spousal impoverishment rules without unusual state twists. The couple may ask the County Assistance Office for a resource assessment, which photographs the couple’s countable resources as of the date continuous institutional care began and fixes the community spouse resource allowance the at-home spouse may keep.
If the at-home spouse’s own income falls short, part of the nursing home spouse’s income can be diverted as a monthly maintenance needs allowance. Either spouse may request a fair hearing to seek a larger allowance in hardship situations.
The asset snapshot is taken on the first day of the continuous stay, not the application date. Families who spend down before asking for a resource assessment often spend money the spouse was entitled to keep.
The Look-Back Rule and Transfer Penalties
Pennsylvania reviews every transfer made in the 60 months before the application. Money or property given away, or sold for less than it was worth, is added up and divided by the state’s penalty divisor — its average private-pay nursing home cost — to produce a period during which Pennsylvania nursing home medicaid will not pay. The divisor in Pennsylvania is $421.20/day (applications filed in 2026).
60 months, federal standard. The IRS annual gift exclusion has no bearing here: a gift that is tax-free can still trigger a Medicaid penalty. Transfers to a spouse, to a disabled child, or of the home to a child who lived there and provided care for two years are the main exceptions.
How to Apply for Pennsylvania Nursing Home Medicaid
Where: The financial application is taken by your local County Assistance Office (CAO), which is the Department of Human Services office serving the county where your relative lives. You can also apply or send documents through the DHS Statewide Customer Service Center at 1-877-395-8930, or 215-560-7226 for Philadelphia residents. Nursing facility social workers commonly help families assemble and submit the packet, but the CAO is the office that actually decides financial eligibility and issues the written notice. — start the application.
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Pennsylvania must find the applicant “nursing facility clinically eligible” (NFCE). A physician completes the MA-51 medical evaluation describing diagnoses and the help needed with activities of daily living, and that finding is supported by a level of care assessment performed by the local Area Agency on Aging, or by the Independent Enrollment Broker for people entering through Community HealthChoices.
The assessor uses the state’s Level of Care Determination tool and reviews bathing, dressing, eating, toileting, transferring, mobility, medication management and cognition. The outcome is either NFCE or nursing facility ineligible.
Bring five years of bank statements, deeds, vehicle titles, insurance policies, the Medicare and Social Security cards, and any trust or power of attorney documents. Missing paperwork is the most common reason a Pennsylvania nursing home medicaid decision is delayed.
While the Application Is Pending
While the application is pending, no one else steps in to pay. The nursing home continues to care for the resident and generally bills privately or holds the account, and families are usually expected to apply the resident’s income toward the bill as it accrues. Federal nursing home rules bar discharging a resident solely because a Medicaid application is pending.
Pennsylvania allows retroactive coverage for eligible medical costs in the months before the application month, so ask the CAO to consider retroactive eligibility. Typical decision time in weeks: UNVERIFIED.
After approval, nearly all of the resident’s income goes to the facility each month as the patient share, minus a small personal needs allowance, health insurance premiums and the spouse’s allowance.
Denials, Appeals and What Comes After
The most frequent problems are missing verification rather than true ineligibility: incomplete bank statements and financial records for the look-back period, unexplained withdrawals, gifts or property transfers to family, life insurance or annuities not disclosed, countable resources still above the limit on the first of a month, or a missing or incomplete MA-51 or level of care determination.
If you receive a denial or reduction notice, file a written appeal with your County Assistance Office, which forwards it to the DHS Bureau of Hearings and Appeals for a hearing before an administrative law judge; further review lies with the Secretary of Human Services and Commonwealth Court.
One more thing families should know before they file: after the resident’s death, the state may seek repayment from the estate. That process — what it can reach and the exemptions — is covered in our guide to Pennsylvania Medicaid estate recovery.
A Realistic Pennsylvania Nursing Home Medicaid Timeline
Week one: the hospital or family calls the Medicaid office for the level-of-care assessment and starts gathering five years of statements. Weeks two to four: the assessment is done and the financial application is filed, usually with the facility’s admissions office helping. Weeks six to twelve: the caseworker verifies accounts and may ask for more documents; answer within the deadline on each request or the clock resets.
Approval, when it comes, is retroactive to the eligibility date, which is why filing early is the single most valuable thing a family can do.
Where to Get Help Free
Two free doors exist in every state: the Pennsylvania SHIP counselor for the Medicare side and the state’s Aging and Disability Resource Center for the Medicaid side. Neither sells anything. For a Pennsylvania nursing home medicaid question involving a house, a spouse at home or a recent gift, a local elder law attorney or legal aid office is the next call.
Key Takeaways: Pennsylvania Nursing Home Medicaid
- Two tests, not one: Pennsylvania nursing home medicaid checks income and assets separately, and passing one does not excuse the other.
- The spouse is protected: the at-home spouse keeps a share of assets and an income floor under Pennsylvania nursing home medicaid before anything is spent down.
- The look-back is five years: any gift inside it is divided by the divisor and becomes months without Pennsylvania nursing home medicaid coverage.
- The home usually does not count: while a spouse lives there, the house is exempt from the Pennsylvania nursing home medicaid asset test.
- Apply as Medicaid pending: most facilities admit while Pennsylvania nursing home medicaid is decided and the state pays back to the eligibility date.
- Assessment first: the level-of-care evaluation is what starts the Pennsylvania nursing home medicaid clock, so request it on day one.
Official Sources
- Pennsylvania does not use a separate brand name for nursing home Medicaid. The state calls its Medicaid program Medical Assistance (MA), and nursing home coverage is described by the Department of Human Services as Medical Assistance long-term care, or nursing facility services. Once approved, most residents receive their care through Community HealthChoices (CHC), the state’s mandatory managed long-term services and supports program overseen by the DHS Office of Long-Term Living, so families will hear both “Medical Assistance” and “Community HealthChoices” used about the same coverage. — Pennsylvania Medicaid: https://www.pa.gov/services/dhs/apply-for-long-term-care-services
- The financial application is taken by your local County Assistance Office (CAO), which is the Department of Human Services office serving the county where your relative lives. You can also apply or send documents through the DHS Statewide Customer Service Center at 1-877-395-8930, or 215-560-7226 for Philadelphia residents. Nursing facility social workers commonly help families assemble and submit the packet, but the CAO is the office that actually decides financial eligibility and issues the written notice.
- Medicaid.gov spousal impoverishment standards: medicaid.gov
- Medicare.gov Medicare Savings Programs: medicare.gov
This Pennsylvania nursing home medicaid guide was checked against the state Medicaid agency, CMS and the statute cited above in September 2026. Figures reset on their own calendars (most on January 1); if a number here disagrees with a notice you received, the notice wins — and please tell us. This page is general information, not legal, financial or medical advice.