Nursing Homes in Pennsylvania: 2026 Cost and Medicaid Coverage

Nursing homes in Pennsylvania are not the same kind of facility as a Personal Care Home or an Assisted Living Residence, even though families often use the three names interchangeably. A nursing home is the one residential setting in PA where Medicaid actually pays the bill for long-stay custodial care. This guide walks through how PA nursing facilities are licensed, what they cost in 2026, how PA Medicaid pays through Community HealthChoices, the spousal-impoverishment and estate-recovery rules that govern long-term stays, and how to pick a facility you can trust.

Start with what sets the three settings apart, because the distinction drives everything that follows. PA nursing facilities are licensed by the PA Department of Health under 28 Pa. Code Chapter 201, federally certified under 42 CFR Part 483 as either a Medicare Skilled Nursing Facility, a Medicaid Nursing Facility, or both, and operated under the Federal Nursing Home Reform Act of 1987 (OBRA-87, codified at 42 USC §§ 1395i-3 and 1396r). PA Personal Care Homes and Assisted Living Residences are licensed by the Department of Human Services under entirely different chapters (55 Pa. Code 2600 and 2800). Different agency. Different regulations. Different acuity. And critically different funding: a nursing facility is the one residential setting in PA where Medicaid actually pays the bill for long-stay custodial care. PCH and ALR are private-pay settings; an NF is the path most PA families end up on for advanced long-term care.

A large share of long-stay residents in Pennsylvania nursing homes rely on Medicaid, paid through the Community HealthChoices managed-care program for adults 21 and older. Private-pay rates are steep: statewide the CareScout 2025 Cost of Care Survey (released March 2026) puts the median semi-private room at about $11,954 a month and a private room at about $13,688 a month, each priced on 365 days of care and above the national line.1 The sections that follow take the key pieces in turn: the licensing framework, 2026 costs, how PA Medicaid pays, the resident's monthly Patient Pay Liability, the spousal-impoverishment and estate-recovery rules, the discharge protections every family should know, and how to pick a facility you can trust.

How Pennsylvania Nursing Homes Are Licensed

PA NFs operate under a layered framework: state licensure under 28 Pa. Code Subpart C, federal certification under 42 CFR Part 483, and the OBRA-87 statutory floor at 42 USC §§ 1395i-3 and 1396r. The PA Department of Health, Bureau of Long-Term Care, is the licensing authority under the Health Care Facilities Act of 1979 (35 P.S. §§ 448.101 to 448.904a). The implementing regulations are in 28 Pa. Code Chapters 201 (general operation), 203 (license applications and fees), 205 (physical-plant standards), 207 (notifications), 209 (fire protection), and 211 (program standards). DOH renews the state license annually, and under contract with CMS, the same DOH surveyors perform the federal certification surveys that determine Medicare and Medicaid participation.

Most PA NFs are dually certified, meaning the same building, the same bed, and the same nurse can be billed as a Medicare Skilled Nursing Facility (Title XVIII, post-acute rehab up to 100 days) on Monday and as a Medicaid Nursing Facility (Title XIX, long-stay custodial care) on Friday. The label depends on which payer is paying. SNF is the Medicare term used for short-stay rehab; NF is the Medicaid term used for long-stay custodial care. A typical PA admission begins as Medicare SNF post-rehab, converts to long-stay Medicaid NF when Medicare runs out, and stays in the same room.

OBRA-87 is the federal foundation. Signed December 22, 1987 as part of the Omnibus Budget Reconciliation Act of 1987, OBRA-87 created the modern NF framework: the Resident Bill of Rights, mandatory comprehensive assessment via the Minimum Data Set and Resident Assessment Instrument, restrictions on physical and chemical restraints, the certified nurse aide training requirement of at least 75 hours, the RN-on-duty rule, the survey and enforcement framework, and PASRR (the Pre-Admission Screening and Resident Review process for residents with serious mental illness or intellectual disability). PA's NF regulations operate above the OBRA-87 floor; PA's December 24, 2022 final-form rulemaking, which raised staffing standards in two phases, was the first comprehensive overhaul of PA NF rules since 1999.

Minimum Staffing and Public Records

Both federal regulation (42 CFR § 483.35(g)) and PA regulation require daily public posting of nurse staffing data in every facility, and PA nursing facilities are inspected each year, unannounced, by the Pennsylvania Department of Health acting as the state survey agency for Medicare and Medicaid.2 Families touring an NF have the practical right to see that daily staffing posting, the most recent CMS Form 2567 statement of deficiencies, and the facility's staffing and quality-measure data published on Medicare's Care Compare tool, which rates every certified nursing home from one to five stars.2 Staffing levels shape day-to-day care more than almost anything else, so read a facility's Care Compare staffing and turnover data closely, not just its headline star rating.

The 2026 Cost Picture

The CareScout 2025 Cost of Care Survey (released March 2026, the most recent state-level data) puts the Pennsylvania statewide median for a semi-private nursing-home room at about $11,954 a month (roughly $143,445 a year) and a private room at about $13,688 a month (roughly $164,250 a year), both priced on 365 days of care and both above the national medians of about $114,975 and $129,575 a year.1 By comparison, assisted living in Pennsylvania runs about $6,352 a month, priced on 12 months of care in a private one-bedroom unit, and non-medical in-home care about $77,792 a year on a 44-hour week over 52 weeks.1 These are industry-survey medians, not government rates and not maximums, and the figure at any one facility can land higher or lower depending on region, room type, and level of care.

Most PA NFs use a base-rate-plus-ancillary model rather than a true all-inclusive rate. The base rate covers the room, meals, basic nursing, social services, activities, in-formulary medications, basic incontinence supplies, and standard linens. Common ancillary charges that fall outside the base rate include out-of-formulary medications (especially branded drugs and specialty drugs like Eliquis or GLP-1 agonists), beauty and barber services, in-room telephones, cable TV upgrades, therapy beyond the Medicare cap when private-paying for additional rehab, special diets in some facilities (kosher, vegan), personal laundry in some facilities, transportation to non-medical appointments, private 1:1 sitters, and bariatric equipment surcharges. Always ask for a written list of base-covered services and a written list of typical ancillary charges before signing the admission contract.

Private-pay rates effectively subsidize Medicaid rates in most facilities, and facilities with a high Medicaid census tend to be the most financially stressed. A family weighing how long to private-pay should think about it strategically: paying privately at a financially stable, well-rated facility is meaningfully different from paying privately at a facility whose long-term stability is uncertain.

How PA Medicaid Pays for Nursing Home Care

This is the single most consequential financial fact about NF care in PA, and it is what distinguishes nursing facilities from PCHs and ALRs in this state.

Pennsylvania Medicaid does pay for nursing home care for residents who meet clinical and financial eligibility. The program is called Medical Assistance Long-Term Care, or institutional MA. Eligibility is administered by the Office of Medical Assistance Programs (OMAP) in PA DHS, while the Office of Long-Term Living (OLTL) handles the LTC operations. Clinical eligibility is established through the Functional Eligibility Determination (FED) instrument administered by the Independent Enrollment Broker (IEB), Maximus PA, at 1-877-550-4227. A resident who is found Nursing Facility Clinically Eligible (NFCE) and who meets the financial tests is then enrolled in Community HealthChoices, the capitated program through which DHS's Office of Long-Term Living administers managed long-term services and supports. CHC enrollment reaches anyone 21 or older who is receiving care in a nursing home paid for by Medicaid, so NF Medicaid reimbursement flows through the participant's CHC managed care organization rather than directly from PA DHS to the facility.6

The financial tests for institutional Medicaid in 2026:3

• Special Income Limit (SIL): $2,982 per month for a single applicant, equal to 300 percent of the 2026 SSI federal benefit rate of $994. Income above the SIL does not end the road: Pennsylvania is a medically-needy state and allows income spend-down, with a medically-needy net-income limit of $2,550 over a six-month budget period (about $425 a month), which distinguishes PA from pure income-cap states. For a nursing-facility applicant this matters more than the raw numbers suggest, because where income exceeds 300 percent of the FBR, DHS treats the anticipated cost of six months of long-term-care facility services as an allowable medical-expense deduction against monthly income, and at PA facility rates that deduction is large enough to bring most applicants under the limit.3,7
• Asset limit (income at or below the SIL): a $2,000 resource limit plus a $6,000 Pennsylvania resource disregard, which works out to $8,000 of countable resources. Both figures are codified at 55 Pa. Code Ch. 178 Appendix A, but DHS publishes them separately and does not publish a single combined $8,000 figure, so expect a caseworker to describe it as "$2,000 plus the disregard" rather than as an $8,000 limit.3
• Asset limit (income above the SIL): $2,400 in countable assets, the medically-needy-only figure in the same appendix.3,7
• 60-month look-back on transfers, with a 2026 transfer-penalty divisor of $421.20 per day (equivalently $12,811.50 per month, up from $399.80 per day in 2025). The uncompensated transfer value divided by $421.20 gives the days of ineligibility. The divisor that applies is the one in effect when the period of ineligibility is determined, not the one in effect when you filed: 55 Pa. Code § 178.104a(d) states the applicant rule as the rate in effect at the time the application is processed, and under § 178.104a(e) DHS instructs County Assistance Offices to use the determination-date rate even when they are authorizing retroactive coverage for a period in which a different rate was in force. Filing in late December does not lock in the older, smaller divisor.4
• Home protection: the home is generally exempt while a community spouse, a child under 21, or a blind or permanently and totally disabled child of any age lawfully resides there. For a sole-occupant institutionalized applicant, an "intent to return" affidavit is typically required to maintain the exemption. The federal home-equity limit bites only in that sole-occupant case: where one of those relatives is living in the home, the home is exempt without regard to the equity cap at all.8 Where none is, equity above the cap disqualifies the applicant, and for 2026 that cap runs from a federal minimum of $752,000 to a state-elected maximum of $1,130,000, indexed annually.8
• Income-only test for the institutionalized applicant: Once the applicant is institutionalized, only the applicant's income counts. Community spouse income remains the community spouse's under the federal "name on the check" rule.

Exempt transfers under the look-back include transfers to a spouse for the spouse's sole benefit, the caregiver-child exemption (a child who lived in the home for at least two years providing care that prevented institutionalization), the sibling exemption (a sibling with an equity interest in the home who lived there for at least one year), transfers to a disabled child of any age, and transfers to special-needs trusts.

Patient Pay Liability: The Resident's Monthly Contribution

Once Medicaid is paying, the resident is not entitled to keep their full income. Under PA LTC Handbook Chapter 468.3, the resident contributes a monthly Patient Pay Liability (PPL) to the facility, and PA Medicaid pays the difference between the per-diem rate and the PPL.

The PPL formula:

• Gross monthly income (Social Security, pensions, annuities, etc.)
• Minus the $60 Personal Needs Allowance (raised from $45 effective January 1, 2025).3
• Minus active health-insurance premiums (Medicare Part B and D, supplements, Medigap)
• Minus the Minimum Monthly Maintenance Needs Allowance (MMNA) to a community spouse, if applicable
• Minus dependent allowances for minor or disabled children
• Minus allowable medical expenses not covered by Medicare or MA
• = Patient Pay Liability

How this works in practice: start from the resident's gross monthly income, then subtract the $60 Personal Needs Allowance, the resident's active health-insurance premiums (for example, the standard 2026 Medicare Part B premium of $202.90, plus any Medigap or Part D premium), any Minimum Monthly Maintenance Needs Allowance owed to a community spouse, dependent allowances, and allowable uncovered medical expenses.3,9 What remains is the Patient Pay Liability the resident owes the facility each month; Medicaid pays the difference between that amount and the facility's per-diem rate, and the resident keeps the $60 allowance for personal items.

The most common errors in PPL calculations are failing to deduct active health-insurance premiums (the most frequent County Assistance Office error), failing to apply the MMNA when a community spouse exists, and not back-billing prior medical expenses (which is allowed within the prior three months of application). If a resident's monthly statement does not show those deductions, ask the facility's business office and the County Assistance Office to recalculate.

Spousal Impoverishment Protections in 2026

When one spouse needs nursing-facility care and the other remains in the community, PA applies the federal spousal-impoverishment framework added by the Medicare Catastrophic Coverage Act of 1988 and codified at 42 USC § 1396r-5. The key protections:

• Community Spouse Resource Allowance (CSRA): a $32,532 floor and a $162,660 ceiling in 2026. PA uses the federal half-and-half methodology: the community spouse keeps 50 percent of countable assets at the date of institutionalization (the "snapshot"), floored at $32,532 and capped at $162,660.3
• Minimum Monthly Maintenance Needs Allowance (MMNA): a monthly income allowance the community spouse may keep. The federal floor is $2,705.00 a month from July 1, 2026 through June 30, 2027, up from $2,643.75 the year before; the maximum monthly maintenance needs allowance is $4,066.50 a month effective January 1, 2026; and the community-spouse excess-shelter standard is $811.50 a month. The floor resets each July 1 with the federal poverty level and the maximum each January.10
• PA-1572 is the form used to capture the snapshot.

Spousal impoverishment is more limited than many families assume. It does not protect more than $162,660 in assets without a fair-hearing or court order for an "expanded resource allowance."3 It does not protect income beyond the MMNA structure: income above the MMNA support need flows back to the resident's PPL. And it does not stop the look-back: gifts in the prior 60 months still count regardless of the community-spouse status. PA uses the federal "income-first" methodology, which is less generous to the community spouse than a "resource-first" approach: before applying additional CSRA above $162,660, PA first applies the institutional spouse's income to make up the community spouse's MMNA shortfall.

Estate Recovery: Why PA Is More Lenient Than Many States

Federal law at 42 USC § 1396p(b)(1) requires every state to recover from the estates of deceased Medicaid recipients age 55 and older for LTC services received. PA's statutory authority is at 62 P.S. § 1412 (Act 49 of 1994), implemented through 55 Pa. Code Chapter 258, and it reaches care received on or after August 15, 1994.5 The operating office is the PA DHS Third Party Liability Section / Estate Recovery, reachable at (800) 528-3708 or RA-PWESTATERECOVERY@pa.gov.

What makes PA different from states like Massachusetts, Ohio, Iowa, or Minnesota is that PA recovers only from the probate estate. Under 55 Pa. Code § 258.3(a), the estate is limited to "all real and personal property of a decedent which is subject to administration by a decedent's personal representative". What passes outside probate is outside the claim. PA does NOT recover from joint tenancy with right of survivorship, tenancy by the entireties (the PA-specific spousal form that is exempt because of survivorship), Payable-on-Death (POD) and Transfer-on-Death (TOD) financial accounts and deeds, beneficiary-designated retirement accounts, life insurance and annuities with named beneficiaries, or assets in a qualifying pre-death trust.5

What is recovered is narrower than most families assume, and the bound matters. PA recovers only the long-term-care Medical Assistance it paid: nursing facility services, home and community-based services, and the related hospital and prescription-drug services, for care received at age 55 or older. It does not recover for all Medical Assistance received at 55 and older; ordinary non-long-term-care medical coverage is outside the program entirely. Federal law at 42 USC § 1396p(b)(1)(B)(ii) separately carves out the Medicare cost-sharing PA paid on behalf of Medicare Savings Program enrollees, so QMB and related premium, deductible, and coinsurance payments are not recoverable either. Pennsylvania has also not adopted the federal expanded-estate option.5,8

Read the survivor protections as a timing bar, not a cancellation. Under 55 Pa. Code § 258.7, collection is postponed until the last of these has occurred: the death of a surviving spouse; the death of a child who is blind or totally and permanently disabled by SSI standards; a surviving child reaching age 21; and the death of, property transfer by, or vacating of the property by a sibling who holds an equity interest and lived in the home for at least one year before the decedent's death. When the last of those events happens, the claim can still be collected against whatever estate property remains.5 The parallel federal protection at 42 USC § 1396p(b)(2)(B), which shields the home where a qualifying sibling (one year before admission) or a caregiver son or daughter (two years before admission, providing care that kept the parent out of a facility) is living in it, carries a condition families often miss: that relative must have lawfully resided in the home continuously since the date of admission. A relative who moved out after admission and later moved back is outside the statutory bar on its face.8

Two waivers are genuine write-offs rather than delays. DHS permanently waives its claim against an administered estate with a gross value of $2,400 or less where there is an heir, and grants undue-hardship waivers under 55 Pa. Code § 258.10, including a primary-residence waiver and an income-producing-property waiver tied to 250 percent of the federal poverty guideline.5

The personal representative of an estate must notify DHS within one month of the grant of letters under 55 Pa. Code § 258.3. DHS must then submit its claim to the personal representative within 45 days of receiving that notice, or the claim is forfeited, which makes prompt, documented notice worth doing exactly right. Failure to notify can create personal liability for the representative.5 PA does not recognize Lady Bird Deeds (Enhanced Life Estate Deeds) for PA real estate, which is a common misconception. The realistic planning toolbox in PA includes irrevocable asset-protection trusts funded outside the 60-month look-back, spousal transfers (unlimited under federal exemption), the caregiver-child transfer for a home, and basic probate avoidance through POD, TOD, joint titling, and trust-based ownership.

Community HealthChoices and Nursing Facility Coverage

Since the CHC rollout completed in 2020, PA's mandatory managed LTSS program is the payment pipeline for Medicaid NF coverage for adults 21 and older. The CHC MCO contracts with the facility and pays the facility directly. Per-diem rates remain floor-protected by OLTL: MCOs must pay at least the OLTL-determined per-diem rate. MCOs may pay above the floor for value-based or quality contracting.

CHC is organized into five zones, and each zone is covered by all three CHC managed care organizations: AmeriHealth Caritas (branded Keystone First CHC in the five-county Philadelphia region), PA Health & Wellness, and UPMC Community HealthChoices.6 That statewide three-MCO coverage is why plan choice and facility choice are separable questions in PA: wherever in the state the facility sits, all three plans operate there.

CHC carries continuity-of-care protections when a participant moves between MCOs, and the 180-day continuity period most often quoted is the one that lets a participant keep existing home and community-based services providers, including service coordinators, through a plan change. For a nursing facility resident the practical question is different and simpler: switching MCOs at annual open enrollment does not mean moving out of the facility, because all three CHC MCOs operate in every zone of the state.6 Ask the facility's business office to confirm its contract with the plan you are considering before you switch.

Medicare SNF Coverage: The 100-Day Benefit

Medicare Part A covers SNF stays under 42 USC § 1395d(a)(2) and 42 CFR § 409.20, up to 100 days per benefit period, but only for short-term, post-acute skilled care, never long-term custodial care.11 The 2026 cost sharing:

• Days 1 to 20: $0 daily copay (after the Part A inpatient hospital deductible of $1,736 per benefit period is met from the prior hospitalization).9
• Days 21 to 100: a daily coinsurance of $217 in 2026.11
• Day 101 and beyond: Medicare pays nothing. The resident pays in full or transitions to Medicaid.11

Medicare SNF coverage requires that the resident had a 3-day inpatient hospital stay (not observation status) within 30 days before SNF admission. Medicare Advantage plans routinely waive this rule subject to plan rules, Original Medicare ACOs and Direct Contracting Entities may waive it, and CMS Hospital-at-Home program participants count even though physically at home. Many dual-eligibles get seamless coverage because Medicaid picks up immediately.

The "skilled need" requirement under 42 CFR § 409.31 means SNF coverage requires daily skilled nursing or skilled rehabilitation services, typically 5+ days per week of physical, occupational, or speech therapy, or daily IV, wound, or respiratory care. Once skilled need ends, Medicare ends regardless of how many days remain in the 100-day benefit. F-tag F580 (notice of non-coverage / SNF ABN) requires the facility to issue a written notice when Medicare is ending; the resident can appeal through the Quality Improvement Organization (QIO).

The pragmatic Day 1 to Day 100 pathway for a typical PA admission: admit on Medicare Part A, first MDS PPS assessment by Day 14, care planning meeting by Day 21, the first cliff at Day 20 when the $217 daily coinsurance kicks in, the next PDPM scheduled assessment at Day 60, and the discharge plan finalized between Days 80 and 100.11 Apply for PA Medicaid at roughly Day 60 if the discharge plan is long-stay, so that Medicaid coverage can be in place by Day 100.

Resident Rights and Discharge Protections

The federal NF Bill of Rights at 42 CFR § 483.10 and PA's parallel provisions in 28 Pa. Code Chapter 211 give every PA NF resident an enforceable list of rights: dignity, respect, self-determination, full information about rights and services in a language they understand, privacy and confidentiality of records, the right to voice grievances without reprisal, the right to participate in care planning (including refusing treatment), the right to personal possessions and chosen visitors, freedom from physical and chemical restraints imposed for discipline or convenience, the right to manage their own financial affairs (or designate a representative), the right to organize a Resident Council and Family Council, freedom from abuse, neglect, exploitation, and misappropriation, transfer and discharge rights, and PASRR rights. The PA Resident Rights wall poster is required in every facility.

Discharge protections under 42 CFR § 483.15 are the most important for families to understand. A PA NF may transfer or discharge a resident involuntarily ONLY for one of six reasons: (1) the transfer is necessary for the resident's welfare and the facility cannot meet their needs; (2) the resident's health has improved and they no longer need NF services; (3) the safety of others is endangered; (4) the health of others is endangered; (5) the resident has failed, after reasonable notice, to pay; or (6) the facility ceases to operate. The facility must provide a 30-day written notice (less if endangerment) that includes the reason, effective date, location of transfer, statement of right to appeal, contact information for the PA LTC Ombudsman, and contact for the State agency. A copy must go to the Ombudsman and to the resident's representative.

The resident may appeal to the PA DHS Bureau of Hearings and Appeals (BHA) within 30 days of the discharge notice. Filing the appeal triggers an automatic stay of discharge during the pendency of the hearing under 55 Pa. Code Chapter 275. Further appeal lies to the Commonwealth Court of Pennsylvania within 30 days of the BHA order. The Pennsylvania Health Law Project (PHLP), the legal-aid organization specializing in PA Medicaid and LTC issues, regularly represents residents in discharge appeals at no cost. PHLP intake is at phlp.org or 1-800-274-3258.

The "hospital dump" pattern (a facility refusing to readmit a resident after a hospitalization, claiming the resident's needs have changed) is a recurring issue in PA and elsewhere. Be precise about what 42 CFR § 483.15(e) does and does not give you. It does not guarantee that the bed itself is held indefinitely: how many days PA Medicaid will pay to hold a bed during hospitalization or therapeutic leave is set by state policy, and the facility must give you its written bed-hold and return policy in advance. What the rule does give the resident is the readmission right: when the resident no longer needs hospital care, the facility must readmit them to the next available bed in a semi-private room, even if the paid bed-hold period has run out. Ask for that written policy at admission rather than during a hospitalization. Refusal to readmit triggers the same discharge appeal rights as any other involuntary discharge.

Pennsylvania's Filial Support Law

This is one of the most consequential PA-specific risks for adult children of nursing-facility residents and one most generic "Medicaid pays for nursing home" framings ignore.

PA's Filial Support Law at 23 Pa. C.S. § 4603 provides that adult children (and parents of indigent adult children) may be held financially responsible for an indigent relative's nursing-facility debt under certain circumstances. Pennsylvania is one of roughly 30 states with a filial-responsibility law on the books, and PA is among the most actively-enforced filial-law states in the country. In the landmark case Health Care & Retirement Corporation of America v. Pittas, 46 A.3d 719 (Pa. Super. Ct. 2012), the Superior Court held an adult son personally liable for his mother's unpaid nursing-facility debt under § 4603. Pittas shocked the elder-law bar nationally and continues to shape PA NF admissions practice today.

The mitigation is not complicated, but it has to happen. Apply for PA Medicaid promptly. Make sure the parent qualifies clinically and financially. Make sure the facility's billing flows through Medicaid rather than running a private balance. Once Medicaid is the payer, filial liability does not attach to the Medicaid-covered amount, because the obligation is no longer the resident's to pay. Where families get into trouble is when an admission contract names an adult child as "responsible party" with personal-guaranty language, the Medicaid application is delayed, and the private balance grows during the gap. Read the admission contract carefully. Decline to sign as a personal guarantor if you can. Have an elder-law attorney review the contract before signing if the dollars at stake are meaningful. The federal SNF arbitration rule allows residents to opt out of mandatory arbitration in admission contracts; that opt-out should be exercised.

How to Pick a Pennsylvania Nursing Home

Once a family has decided NF is the right setting, the question is which one. PA gives families genuinely useful tools.

CMS Care Compare (medicare.gov/care-compare) is the central database. Each PA NF has an Overall 5-Star Rating that combines three component ratings: Health Inspection (based on the most recent two standard surveys plus recent complaint surveys, after a methodology change in July 2025), Staffing (derived from Payroll-Based Journal data for RN HPRD and total nurse HPRD adjusted for resident acuity), and Quality Measures (a composite of MDS-based outcomes including antipsychotic use, falls with major injury, pressure ulcers, urinary tract infection rate, and hospitalization rate). Health Inspection is state-relative (top 10 percent within state earns 5 stars, bottom 20 percent earns 1 star); Staffing and QM are national. Care Compare also reports staff turnover separately, which is one of the most useful indicators a family can review.

What 5-Star tells you: survey deficiencies, staffing levels, outcomes. What it does not tell you: corporate ownership history, recent ownership change (often a 6 to 12 month lag in Care Compare), behavioral-health resident mix, staff turnover (separately reported), short-stay vs. long-stay specialization. Read the full Form CMS-2567 statement of deficiencies for the most recent surveys, not just the rating.

PA DOH Nursing Home Reports (pa.gov/agencies/health/health-statistics/health-facilities/nursing-home-reports) is the state-side equivalent. Search by facility name or county. View standard surveys, complaint surveys, and revisit surveys, including the full Form CMS-2567. ProPublica's Nursing Home Inspect (projects.propublica.org/nursing-homes) offers an easier-to-search interface over the same underlying data.

The PA Long-Term Care Ombudsman Program is the resident-advocacy resource families do not use enough. Statewide intake is 717-783-8975 or LTC-ombudsman@pa.gov, housed in the PA Department of Aging. Fifty-plus regional ombudsmen across the state, including the Southwest PA AAA Ombudsman at 855-450-2274 and the Philadelphia Corporation for Aging Ombudsman, work directly with residents and families. Ombudsmen are confidential: residents control whether the ombudsman acts on a concern.

Tour questions worth asking, in roughly the order they matter:

• "What is your direct-care HPRD on a typical weekday? Weekend? Night shift?"
• "May I see your most recent CMS-2567 statement of deficiencies?"
• "What is your CNA staff turnover for the last 12 months?"
• "Do you accept PA Medicaid (Community HealthChoices)? With which MCOs do you contract?"
• "What is your bed-hold policy for hospitalization?"
• "How many residents per CNA on day, evening, and night shifts?"
• "Are you a Special Focus Facility candidate, or have you been on the SFF list recently?"
• "What are your wound-care, IV, and behavioral-health capabilities?"
• "Is there a Resident Council and a Family Council? When do they meet?"
• "What are your private-pay base rates? What ancillaries are extra?"

Red flags that warrant a second look: recent corporate ownership change (often a 6-month lag in Care Compare data), high percentage of residents on antipsychotic medications, high hospitalization rate (residents bouncing back to the ER), Special Focus Facility status or candidate list, multiple complaint substantiations in the last 12 months, and CNA turnover above 50 percent.

Memory Care and Dementia Units Within PA Nursing Facilities

A Pennsylvania nursing facility delivers around-the-clock skilled nursing care under a single Department of Health license, a higher level of care than a personal care home or assisted living residence provides.2 That single license is the point here: PA does not have a separate "memory care unit" license for nursing facilities, unlike its separate Special Care Unit regimes for Personal Care Homes (55 Pa. Code Chapter 2600) and Assisted Living Residences (55 Pa. Code § 2800.231). An NF may designate a wing or floor as a dementia Special Care Unit (SCU) within its existing DOH license, but the designation is operational rather than a separate state license category. The federal regulation at 42 CFR § 483.10(g)(13) and the CMS State Operations Manual reference SCUs but no federal certification regime exists for dementia units in NFs.

A typical PA NF dementia unit features: locked or coded-access wings for elopement risk, higher staff-to-resident ratios, specialized programming (validation therapy, music therapy, sensory rooms), dementia-specific staff training that typically exceeds the modest minimums PCHs and ALRs face, wandering paths, secured outdoor spaces, and lower-stimulation dining and bathing routines. SCU placement often carries a monthly premium over the base NF rate for private-pay residents, so ask each facility what a secured-unit stay adds to the base rate. Medicaid does not pay a higher per-diem for SCU placement specifically, although the case-mix index does adjust upward for high-acuity dementia residents whose MDS reflects complex behavioral-health needs.

Comparison: NF, PCH, ALR, and LIFE

The four main PA long-term-care settings differ in who licenses them, what they cost, and who pays: a nursing facility, a Personal Care Home, an Assisted Living Residence, and the LIFE (Living Independence for the Elderly, the PA name for PACE) program. The nursing-facility cost figures below are the CareScout 2025 statewide medians, priced on 365 days of care.1

Where Brevy Comes In

Choosing a nursing facility, applying for PA Medical Assistance Long-Term Care, calculating Patient Pay Liability, evaluating spousal-impoverishment options, and weighing whether to pursue LIFE as an alternative to NF for an NFCE-eligible parent are all decisions that benefit from a clear-eyed look at the numbers. Brevy is building the most trusted source of PA LTC information in the country. If you would like a hand walking through which CHC MCO contracts with the facility you are considering, what your PPL is likely to be, or how to think about the filial-support exposure on an admission contract, message Brevy or visit brevy.com to start a conversation.

Key 2026 Pennsylvania Nursing Facility Facts

• PA nursing facilities are licensed and inspected by the Pennsylvania Department of Health, which also runs the Medicare and Medicaid certification surveys.2 Medicaid NF coverage is paid through Community HealthChoices for anyone 21 or older receiving nursing-home care paid for by Medicaid.6
• Median 2026 private-pay cost: about $11,954 per month semi-private and $13,688 private statewide, both priced on 365 days of care and above the national medians of about $114,975 and $129,575 a year.1
• Special Income Limit (300% SSI): $2,982 per month for a single applicant in 2026. Asset limit: $8,000 with the $6,000 PA disregard when income is at or below the limit, $2,400 when income is above it.3
• Transfer-penalty divisor: $421.20 per day in 2026. Look-back: 60 months.4
• CSRA range $32,532 to $162,660 in 2026.3
• NF Personal Needs Allowance: $60 per month, raised from $45 effective January 1, 2025.3
• Medicare SNF coinsurance 2026: $217 per day for days 21 to 100; the Part A inpatient hospital deductible is $1,736 per benefit period.11,9
• PA estate recovery is probate-only and reaches only long-term-care Medical Assistance received at 55 or older, on or after August 15, 1994; Medicare Savings Program cost-sharing is excluded by federal law. Assets passing outside probate (joint tenancy, tenancy by the entireties, POD/TOD accounts and deeds, beneficiary-designated retirement accounts, named-beneficiary life insurance and annuities, a qualifying pre-death trust) are outside the claim. Estates of $2,400 or less with an heir are permanently waived.5
• LTC Ombudsman: 717-783-8975 / LTC-ombudsman@pa.gov. PHLP: 1-800-274-3258. Maximus PA IEB: 1-877-550-4227.

Common Misconceptions

• "Medicaid only pays for the nursing home after you spend down to zero." False. PA's two-tier asset limit allows up to $8,000 in countable assets for applicants at or below the income limit. Married couples retain a Community Spouse Resource Allowance of up to $162,660 for the community spouse. Many resources are exempt entirely (the home in defined circumstances, one car, prepaid burial, household goods).3
• "The nursing home will take my mom's house." Overstated. The NF itself never takes the house; Medicaid estate recovery sometimes does. PA is probate-only, and non-probate transfers (joint, POD, TOD, trust) escape recovery. Multiple statutory exemptions protect surviving spouses, minor or disabled children, caregiver children, and equity-interest siblings. A modest probate-avoidance plan often eliminates exposure entirely.
• "Spousal impoverishment protects everything for the at-home spouse." Overstated. The CSRA is capped at $162,660, and the MMNA has its own federal cap. Above these levels, expanded resource or income allowances require a fair hearing or court order.3
• "5-Star nursing homes are always better than 1-Star ones." Oversimplified. 5-Star is state-relative for the Health Inspection domain. The rating reflects historical survey performance and lags recent ownership changes. Read the deficiencies, the staffing data, and the QM domain together, not the overall star alone.
• "Medicare pays for nursing home care." Misleading. Medicare pays for post-acute SNF rehab up to 100 days per benefit period, only when daily skilled need persists. Medicare does not pay for long-term custodial care. After Day 100, residents transition to private-pay or Medicaid.11
• "If I give my house to my kids, Medicaid won't take it." Dangerous half-truth. A gift triggers a 60-month look-back, and the uncompensated value divided by the $421.20 daily penalty divisor sets the days of ineligibility. "Just transfer the house" without a 60-month head start is one of the most common, most costly errors families make in PA.4
• "I have to choose one MCO, and that locks me into one nursing home." False. All three CHC MCOs operate in every one of PA's five CHC zones, so plan choice and facility choice are separate decisions statewide.6 Confirm the specific facility's contract with the plan before switching.
• "Personal Care Homes and Assisted Living are the same as nursing homes." False. Different licensing agency (DHS vs. DOH), different regulations (55 Pa. Code 2600/2800 vs. 28 Pa. Code 201/211), different acuity, different funding. PCH and ALR cannot legally accept residents with continuous skilled-nursing needs; NFs can.

Learn More

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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.