Pennsylvania Medicaid Eligibility and Income Limits (2026)

Pennsylvania does not even call its Medicaid program "Medicaid," and the renaming is the gentlest surprise its long-term-care rules hold for families. The state calls it Medical Assistance, a label that traces to the 1968 Public Welfare Code and that still shows up on every form, denial letter, and county-office sign in 2026. This is the first thing families learn when they start applying. It will not be the last surprise.

Pennsylvania runs Medical Assistance long-term care eligibility through a financial framework that looks, at first glance, like every other state's: a 5-year lookback, a federal asset limit, a federal spousal-protection ceiling. Look closer and Pennsylvania starts to diverge. The asset limit is two-tiered, $2,400 for some applicants and $8,000 for others, depending on income alone. The home equity exemption sits at the federal lower bound ($752,000 for 2026), not the upper. The Personal Needs Allowance was raised in January 2025 from $45 to $60, the first increase in 18 years. And the lookback enforcement runs through a daily penalty divisor ($421.20/day in 2026), not the monthly divisors most other states use, which means transferring assets in Pennsylvania produces fractional-day penalties that no spreadsheet template from another state will compute correctly.

This guide is written for the family member, professional caregiver, or attorney who needs to know the actual 2026 numbers, the actual rules behind those numbers, and the worked examples that show how the rules play out for real Pennsylvanians. It is anchored on Pennsylvania DHS bulletins, the Pennsylvania Code, the OLTL handbooks, the SSA 2026 COLA fact sheet, and the Pennsylvania elder-law bar's published commentary, all dated 2025–2026. Where rules diverge from the rest of the country, we say so. Where Pennsylvania is genuinely more generous than its neighbors (and it is, in important places), we say so too.

What Medical Assistance Actually Covers for Long-Term Care

Pennsylvania Medical Assistance (MA) covers long-term care through three primary mechanisms:

1. Nursing Facility Care. Traditional fee-for-service Medical Assistance for nursing-facility residents. About 70,000 Pennsylvanians receive MA-financed nursing-facility care at any given time. Benefits cover room and board, skilled nursing, therapies, and medical care; the resident contributes nearly all monthly income (after the $60 PNA, the spousal allowance if any, and an allowance for medical expenses) toward the cost of care, and Medical Assistance pays the difference.

2. Community HealthChoices (CHC) Waiver. Pennsylvania's mandatory managed long-term services and supports (MLTSS) program for adults 21+ who are dual-eligible for Medicare and Medicaid OR who meet nursing-facility level of care and qualify financially. CHC went statewide effective 1/1/2020 (after a phased rollout that started in southwest PA on 1/1/2018). It absorbed the Aging Waiver, the Independence Waiver, the Attendant Care Waiver, and the CommCare Waiver between 2017 and 2019, all four of those legacy waivers are now closed. About 430,000+ Pennsylvanians are enrolled in CHC in 2026, served by three managed-care organizations: AmeriHealth Caritas Pennsylvania (branded as Keystone First in the 5-county Philadelphia region), PA Health & Wellness (Centene), and UPMC Community HealthChoices. A 2024 reprocurement added two new plans (Aetna Better Health PA and Vista Health Plan / Health Partners Plans) for the next contract cycle, though the launch date has been pushed by readiness reviews and procurement protests.

3. LIFE Program (Living Independence For the Elderly). Pennsylvania's branding for the federal Program of All-Inclusive Care for the Elderly (PACE). About 8,400 Pennsylvanians are enrolled across roughly 30+ LIFE provider sites in 2026, the third-largest PACE enrollment in the U.S. LIFE participants are 55+, nursing-facility-clinically-eligible, live in a LIFE provider's service area, and can be safely served in the community. LIFE delivers all Medicare and Medicaid services through a single capitated provider, primary care, specialty care, hospital, pharmacy, transportation, adult day health, and home care all integrated under one organization. LIFE is voluntary opt-in; CHC is mandatory for eligible 21+ adults, and LIFE participants are excluded from CHC.

The financial eligibility rules in this guide apply to all three pathways. The income limit is the same. The asset limit is the same. The lookback is the same. The penalty divisor is the same. The financial gate does not change based on which long-term care setting an applicant ultimately uses.

The 2026 Numbers, At a Glance

Pennsylvania's Two-Tier Asset Limit, The Single Most Important Concept in PA Eligibility

Most Medicaid asset rules across the country use a single fixed asset limit. Pennsylvania does not. Pennsylvania uses two distinct asset limits, and which one applies to a given applicant depends on their gross monthly income.

Tier One, $8,000

If the applicant's gross monthly income is at or below the Special Income Limit ($2,982/month for 2026), the asset limit is $8,000, composed of a $2,000 federal base plus a $6,000 Pennsylvania disregard. This $6,000 disregard is created by Pennsylvania state regulation (55 Pa. Code § 178.2) and does not exist in most states.

Tier Two, $2,400

If the applicant's gross monthly income exceeds the Special Income Limit ($2,982/month), the asset limit drops to $2,400, the $6,000 PA disregard is forfeited.

Why the structure exists

Pennsylvania's two-tier structure originated as a policy compromise: the state wanted to preserve a lower asset limit ($2,400) for higher-income applicants pursuing the Medically Needy spend-down pathway, while creating a larger asset cushion ($8,000) for low-income applicants who hold their assets in modest savings, burial reserves, or vehicles. The effect is that low-income Pennsylvanians can keep up to $8,000 in countable resources without disqualifying themselves, a meaningful improvement over the $2,000 federal base used in most other states.

Worked example, couple where one spouse is institutionalized

Hilda is 84 years old and was admitted to a nursing facility in Allegheny County on March 15, 2026. Her husband Frank, 86, lives in their longtime home. Hilda receives Social Security of $1,840/month and a small pension of $410/month, total $2,250, which is below the SIL of $2,982. Hilda also has $7,200 in a checking account in her name and $32,000 in a joint money-market account with Frank.

• Hilda's income ($2,250) is below the SIL → Tier One asset limit of $8,000 applies to Hilda's countable resources.
• Hilda's countable resources include $7,200 in her sole checking + half of the joint money-market ($16,000) for a snapshot value of $23,200 (before CSRA calculations).
• CSRA snapshot: Pennsylvania uses federal half-and-half methodology. The countable couple resources at the moment of institutionalization total $39,200 ($7,200 + $32,000). Frank, as community spouse, keeps half ($19,600), but the federal floor of $32,532 raises Frank's CSRA to $32,532.
• Hilda's available countable resources after CSRA: $39,200 − $32,532 = $6,668. This is below Hilda's Tier-One asset limit of $8,000, so Hilda is resource-eligible the day she is institutionalized.
• Hilda's income flow under MMNA: Hilda's monthly income of $2,250 flows first to her $60 PNA, then a portion to Frank to bring Frank up to the MMNA base ($2,643.75/month + any excess shelter allowance up to $4,066.50). After Frank receives his MMNA share, the residual income flows to the nursing facility as Hilda's contribution toward cost of care; Medical Assistance pays the difference.

Worked example, applicant whose income exceeds the SIL

Charles is 78, a retired electrical engineer in Lancaster County. He has Social Security of $2,400/month and a pension of $1,250/month, total $3,650/month, which exceeds the SIL of $2,982. Charles holds $4,800 in a checking account and a $24,000 IRA in distribution.

• Charles's income ($3,650) is above the SIL → Tier Two asset limit of $2,400 applies.
• Charles's countable resources: $4,800 + $24,000 = $28,800 (the IRA in distribution is countable in Pennsylvania for an unmarried applicant).
• Charles is NOT resource-eligible for institutional MA at his current asset level.
• Charles's pathways forward:
  • Spend down resources to $2,400 through legitimate spending: prepaid burial up to $1,500 (irrevocable), home repairs, replacement vehicle, payment of legitimate debts, or medical bills. Most of the $26,400 in excess resources can be spent down within a few months without triggering transfer-penalty issues.
  • Pursue the Medically Needy pathway, but the MNIL ($425/month single) is far below Charles's $3,650 income. He would need to spend down monthly through submitted medical bills. For institutional applicants, the simpler path is direct asset spend-down to $2,400 plus monthly income contribution toward facility cost.
  • Establish a Qualified Income Trust (Miller Trust). Charles can shelter income above the SIL by depositing the excess into a QIT. PA permits QITs as one of two pathways for over-income applicants, the other being Medically Needy spend-down. Most PA elder-law attorneys will recommend the spend-down pathway for institutional cases unless an applicant has specific reasons to use a QIT (e.g., extremely high income that makes spend-down impractical).

Pennsylvania's Spend-Down Flexibility, The Key Difference From Texas and Florida

This is one of Pennsylvania's most important features and one that families relocating from income-cap states routinely miss.

Texas and Florida are pure income-cap states. If your gross monthly income exceeds 300% of SSI, you are categorically ineligible for institutional or waiver Medicaid. The only path forward is a Miller Trust / Qualified Income Trust, you must establish the trust, deposit excess income into it, and the trust pays for medical care. There is no spend-down pathway through medical bills.

Pennsylvania is a Medically Needy state. Pennsylvania permits applicants whose income exceeds the SIL to qualify through one of two pathways:

1. Spend-down through medical bills. The applicant submits medical bills for the 6-month spend-down cycle. Once submitted bills equal or exceed the difference between actual income and the MNIL ($425/month single), MA eligibility is established for the remainder of the cycle.

2. Qualified Income Trust (Miller Trust). As an alternative pathway, the applicant establishes a QIT and deposits monthly income above the SIL. The trust pays a designated portion to the spousal allowance, the personal needs allowance, and the nursing-facility cost; MA pays the remainder.

The practical effect: in Pennsylvania, an over-income applicant rarely needs a Miller Trust. The Medically Needy pathway is usually simpler, especially for institutional cases where monthly nursing-facility costs ($10,000–$15,000+) far exceed the applicant's income, automatically generating enough medical bills to satisfy spend-down. This is one of the reasons PA elder-law attorneys typically recommend the Medically Needy pathway for nursing-facility cases and reserve QITs for unusual situations.

If you are a family member helping a Pennsylvania applicant whose income is above $2,982/month, you should know: a Miller Trust is not required in Pennsylvania the way it is in Texas or Florida. You have a choice. In most cases, you do not need to set up a trust at all.

The Personal Needs Allowance, Raised in 2025 After 18 Years

For Pennsylvania nursing-facility residents enrolled in Medical Assistance, the Personal Needs Allowance is $60/month in 2026.

Until December 31, 2024, the PNA was $45/month, a figure that had been unchanged since 2007. Pennsylvania DHS announced the increase to $60/month effective January 1, 2025, through Chapter 468.3 of the LTC Handbook and an OLTL operations memorandum.

What does the PNA cover? The PNA is the only money a Medicaid-financed nursing-facility resident is permitted to retain for personal expenses. Out of the PNA, residents pay for: clothing and shoes; toiletries beyond what the facility provides; haircuts and personal care; phone service, magazines, and recreation; small gifts; co-pays the facility does not cover; over-the-counter items; transportation for visits.

How does PA's PNA compare nationally? At $60, Pennsylvania sits above New York's $50/month (the lowest in the country) and matches Michigan's $60. The national median PNA is approximately $75. Several states have moved aggressively higher, Washington at $77.81, Oregon at $75, California at $80, Florida at $130. Pennsylvania advocates (including the Pennsylvania Health Law Project) have called for further increases, but no PA legislation comparable to New York's S.4581/A.5126 (which would raise NY's PNA to $200/month) has been introduced in PA as of May 2026.

For families: the PNA is one of the rare areas in nursing-facility Medical Assistance where adult children and grandchildren can directly help, by providing additional spending money for the resident through visits, gift cards, or arranged purchases. Money provided to the resident by family members is not treated as income for MA purposes if it is used for the resident's own benefit; this is one of the few "carve-outs" that PA elder-law attorneys routinely flag during family planning conversations.

Home Equity, The Federal Lower Bound

Pennsylvania uses the federal lower-tier home equity limit of $752,000 for 2026 (up from $730,000 in 2025). This is a meaningful contrast with New York, which uses the federal upper bound of $1,130,000.

• If an applicant's home equity is $752,000 or below, the home is exempt from countable resources.
• If equity exceeds $752,000, the applicant is ineligible for institutional MA until equity is reduced (sale, partial sale, or reverse mortgage proceeds drawing down equity).
• If a community spouse, a child under 21, or a blind/disabled child of any age resides in the home, the equity cap does not apply, the home is fully exempt regardless of value. This is the most important exception and applies in roughly two-thirds of married-applicant cases.
• For sole-occupant applicants who are institutionalized, an "intent to return" affidavit is generally accepted for the first 6 months of institutionalization to maintain home exemption.

For most Pennsylvania families, the $752,000 cap is academic, the median home value in Pennsylvania in 2026 is approximately $260,000, and even in higher-cost markets like Bucks County, Chester County, and Montgomery County, median home values fall well below $700,000. Pennsylvania's equity-cap problem is concentrated in a handful of higher-end Philadelphia suburbs and a small share of Pittsburgh-area properties. Where it does apply, it can derail an application until equity is reduced, usually by sale or by a draw on a reverse mortgage proceeds account.

The 5-Year Lookback and the Daily Penalty Divisor

Pennsylvania uses the federal 60-month lookback and Pennsylvania's annual penalty divisor of $421.20 per day (≈$12,811.50/month) for 2026 calculations.

Why the divisor matters

When DHS finds that an applicant transferred assets for less than fair market value during the 60 months prior to filing, the agency calculates a transfer penalty, a period of time during which Medical Assistance will not pay for the applicant's nursing-facility or HCBS waiver care. The penalty is computed by dividing the value of the uncompensated transfer by the penalty divisor.

The daily divisor is a Pennsylvania peculiarity

Most states use a monthly divisor and round penalties to whole months. Pennsylvania uses a daily divisor, meaning a transfer of $50,000 produces a penalty of approximately 119 days (50,000 ÷ 421.20 ≈ 118.7 days), not 4 months and a fractional rounding adjustment. This is administratively cleaner and avoids the rounding distortions some states encounter, but it also means that fractional-day penalties matter, a transfer of $5,000 produces an approximately 12-day penalty (5,000 ÷ 421.20 ≈ 11.9 days), not "less than a month."

Worked example, the half-loaf strategy

Henry, 81, lives in Erie County and has $300,000 in savings beyond his exempt assets. He is healthy now but anticipates a nursing-facility need within 5 years. Henry consults a PA elder-law attorney in March 2026.

The classic half-loaf strategy (sanctioned in Pennsylvania) works as follows:

• Henry transfers $150,000 to his daughter Anna in March 2026, this transfer is uncompensated and creates a transfer penalty of 150,000 ÷ 421.20 ≈ 356 days (~11.7 months) when Henry eventually applies for MA.
• Henry retains $150,000 in his name, in a structured payment plan (a private annuity, a deferred gift, or an interest-bearing note).
• When Henry enters a nursing facility (suppose 4 years later, in March 2030), he applies for MA. He is "otherwise eligible", his retained $150,000 has been spent on private-pay care, leaving him at the asset limit. The 356-day penalty period begins on the date he becomes "otherwise eligible."
• During the 356-day penalty period, Henry pays for his nursing-facility care from the $150,000 he retained (or from the structured payments). After 356 days, the penalty expires and MA begins paying.

The half-loaf strategy is legal and routinely used in Pennsylvania, but it requires careful execution by a knowledgeable elder-law attorney. The structured-payment vehicle (annuity or note) must comply with PA rules, particularly the requirement that it be actuarially sound, non-cancellable, non-assignable, and pay back to Henry (not his heirs) during his lifetime. Do not attempt this without specialized legal counsel.

Exempt transfers, what does NOT trigger a penalty

Several categories of transfers are exempt from the lookback:

• Sole-benefit-of-spouse transfers (federal exemption, a spouse can receive any amount).
• Caregiver-child exception, an adult child who lived in the parent's home for at least 2 years immediately preceding the parent's institutionalization and who provided care that allowed the parent to delay institutionalization. The home itself can be transferred to this caregiver child without penalty.
• Sibling-with-equity-interest, a sibling who has equity in the home and who lived in the home for at least 1 year before the applicant's institutionalization.
• Transfers to disabled children of any age.
• Transfers to a special needs trust under 42 USC § 1396p(d)(4)(A) for a disabled person under 65.
• Transfers to a pooled trust under 42 USC § 1396p(d)(4)(C) for a disabled person under 65.

Hardship waivers

If a transfer penalty would deprive the applicant of medical care necessary to sustain life, or of food, shelter, or other necessities of life, the applicant can request a hardship waiver under 55 Pa. Code § 258. Hardship waivers are granted infrequently, but they exist as a safety valve.

Spousal Protections, CSRA and MMNA

When one spouse is institutionalized in Pennsylvania and the other remains in the community, three federal protections (which Pennsylvania administers at federal-maximum levels) apply:

Community Spouse Resource Allowance (CSRA)

The CSRA is the amount of countable resources the community spouse is allowed to retain. Pennsylvania uses the federal half-and-half methodology:

• At the date of institutionalization, all countable resources are tallied, the resource snapshot.
• The community spouse is entitled to retain half of the snapshot value, capped at the federal maximum of $162,660 (2026) and floored at the federal minimum of $32,532 (2026).
• Pennsylvania uses PA-1572 (Resource Assessment Form) to lock the snapshot at the moment of institutionalization. Filing the PA-1572 promptly after institutionalization is one of the most important early steps a family can take.

Minimum Monthly Maintenance Needs Allowance (MMNA)

The MMNA is the amount of monthly income the community spouse is permitted to retain (or to receive from the institutionalized spouse). For 2026:

• MMNA maximum = $4,066.50/month (effective 1/1/2026).
• MMNA base = $2,643.75/month (effective 7/1/2025–6/30/2026).
• Excess shelter standard = $794/month (effective 7/1/2025–6/30/2026), used to compute MMNA above base.

Pennsylvania uses the income-first methodology, the community spouse first receives income from the institutionalized spouse to bring her up to the MMNA, before any additional resources can be retained beyond CSRA.

Worked example, CSRA + MMNA together

Marie, 79, is institutionalized in Bucks County. Her husband Joseph, 81, lives in their home. At institutionalization, the couple has $185,000 in countable resources (savings, brokerage, bond fund). Marie's income is $2,750/month. Joseph's income is $1,300/month.

• CSRA: Half of $185,000 = $92,500. This falls between the floor ($32,532) and the ceiling ($162,660), so Joseph keeps $92,500.
• Marie's resources to spend down: $185,000 − $92,500 = $92,500 (Marie). Marie's Tier-One asset limit (income $2,750 ≤ SIL $2,982) is $8,000. Marie must spend down $92,500 − $8,000 = $84,500 before resource-eligibility.
• MMNA computation for Joseph: Assume Joseph's shelter expenses (mortgage, utilities, property taxes, insurance) are $1,800/month. Standard utility allowance and excess shelter standard ($794) feed into the formula; Joseph's calculated MMNA, suppose, comes out to $3,200/month.
• Income flow at MA eligibility: Marie's $2,750 income flows first to her PNA ($60), then a portion to Joseph to bring him to the MMNA, Joseph already has $1,300/month, so he is short $1,900 to reach his $3,200 MMNA. Marie transfers $1,900/month from her income to Joseph. Marie's remaining income ($2,750 − $60 − $1,900 = $790/month) flows to the nursing facility as Marie's cost-of-care contribution. MA pays the remaining facility bill (typically ~$10,000+/month).

When does the snapshot happen?

The snapshot date is the first day of the first continuous period of institutionalization that lasts 30+ days. This is a federal definition that Pennsylvania follows. A short hospital stay does not reset the snapshot; an extended hospital stay followed by nursing-facility admission can reset it. PA elder-law attorneys typically file the PA-1572 within 30 days of admission to lock the snapshot.

Categorical Eligibility, Pennsylvania as a 1634 State

Pennsylvania has a Section 1634 agreement with the Social Security Administration. The practical implication is that SSA's SSI determination automatically establishes Pennsylvania Medical Assistance eligibility, no separate state application is needed for SSI recipients.

This contrasts with the 209(b) states (Connecticut, Illinois, Missouri, and a handful of others), which apply criteria more restrictive than SSI for Medicaid eligibility and require a separate Medicaid determination. In Pennsylvania, if you are receiving SSI, you are automatically receiving Medical Assistance in the SSI-linked categorically needy category.

The pathways for non-SSI applicants in Pennsylvania include:

• Aged 65+ NMP-MA (Non-Money Payment Medical Assistance), categorically needy with SSI-equivalent income.
• Blind/Disabled NMP-MA, categorical based on SSA disability determination.
• Aged/Blind/Disabled MNO-MA (Medically Needy Only Medical Assistance), the spend-down pathway; MNIL $425 single / $442 couple on a semi-annual basis.
• Special Income Limit (300% pathway), institutional and waiver eligibility at 300% of the SSI Federal Benefit Rate.
• MAGI Medicaid, for parents and Medicaid expansion adults, up to 138% FPL. (Pennsylvania expanded Medicaid effective 1/1/2015 under the ACA.)

For LTC applicants, almost always 65+ or disabled, the relevant pathways are categorical NMP-MA (under-SIL income), MNO-MA (over-SIL income via spend-down), or 300% SIL waiver/institutional pathways.

Healthy Horizons (Medicare Savings Programs)

Pennsylvania's Healthy Horizons program is the state's branding for the federal Medicare Savings Programs (MSPs). For dual-eligible Medicare/MA applicants, qualifying for the relevant MSP tier means Medicaid pays Medicare premiums and (for QMBs) cost-sharing:

• QMB (Qualified Medicare Beneficiary), at or below 100% FPL. Medicaid pays Medicare Part A and B premiums, deductibles, and coinsurance.
• SLMB (Specified Low-Income Medicare Beneficiary), 100–120% FPL. Medicaid pays Medicare Part B premium only.
• QI-1 (Qualifying Individual), 120–135% FPL. Medicaid pays Medicare Part B premium (limited federal funding allocation; first-come first-served annually).

Authority: 55 Pa. Code Ch. 140 Subch. B. Most Pennsylvania CHC enrollees are QMBs.

Pennsylvania's Probate-Only Estate Recovery, The Marquee Consumer Protection

This is the single most important consumer-friendly feature of Pennsylvania Medical Assistance, and it is regularly missed by families relocating from expanded-recovery states.

Pennsylvania recovers Medical Assistance expenditures only from the probate estate of the deceased recipient. Recovery does NOT reach:

• Joint tenancy with right of survivorship
• Life-insurance beneficiary designations
• Payable-on-death (POD) and transfer-on-death (TOD) accounts
• Transfer-on-death deeds
• Irrevocable trust assets payable to others
• Living trust assets payable to others

This is the same scope as New York and contrasts sharply with the ~24 expanded-recovery states (e.g., Massachusetts, Ohio, Iowa, Minnesota, Indiana) that recover from non-probate transfers as well.

Statutory framework

• 62 P.S. § 1412 (Act 49 of 1994)
• 55 Pa. Code Chapter 258
• 42 U.S.C. § 1396p(b)(1) (federal mandate)

What is recoverable

When recovery applies, Pennsylvania can recover all Medical Assistance paid on behalf of the decedent on or after age 55:

• LTC services (NF, HCBS, LIFE)
• Medicare cost-sharing under MSP
• Hospital and prescription-drug services for LTC recipients
• Capitation payments to MCOs (CHC, HealthChoices)

Statutory exemptions

Recovery is deferred or waived if any of the following exists at the recipient's death:

• Surviving spouse (recovery deferred until spouse's death)
• Surviving child under age 21
• Surviving blind or disabled child of any age
• Sibling with equity interest who lived in home 1+ year before institutionalization
• Adult child caregiver who lived in home 2+ years before institutionalization

De minimis threshold

Pennsylvania does not pursue recovery against probate estates with gross value of $2,400 or less. This threshold disposes of a substantial portion of low-value estates without administrative cost.

Estate Recovery Hardship Waivers

Two specific hardship-waiver forms are available under 55 Pa. Code § 258.10:

• "Undue Hardship Waiver Request Form"
• "Undue Hardship Waiver, Income Producing Property Request Form"

These are reviewed on a case-by-case basis. Common grants: when recovery would deprive a surviving family member of their primary residence, or would force the loss of an income-producing family farm or small business.

Notice requirement and procedural deadlines

Under 55 Pa. Code § 258.3, the personal representative of the decedent's estate must notify DHS within 1 month of the grant of letters testamentary or letters of administration. DHS then has 45 days to respond with the claim amount. Failure to give notice does not extinguish DHS's claim, but the personal representative may incur personal liability for distributions made before resolving the DHS claim.

Estate recovery contact

DHS Estate Recovery: (800) 528-3708 / RA-PWESTATERECOVERY@pa.gov

What this means for planning

If a Pennsylvania applicant transfers the house to a child via a transfer-on-death deed or holds the house in joint tenancy with right of survivorship with a non-spouse, the house passes outside probate at death and is therefore NOT subject to estate recovery. Combined with the federal 60-month lookback (which only penalizes transfers in the 5 years prior to MA application, not transfers made earlier in life), Pennsylvania's probate-only framework gives families considerable planning flexibility.

For families with significant non-probate planning, beneficiary designations, joint accounts, transfer-on-death deeds, or trust assets, Pennsylvania's framework can mean the difference between recovering 80%+ of an estate (in an expanded-recovery state) versus recovering little or nothing (in PA's probate-only framework). This is a marquee planning consideration that typically warrants consultation with a PA elder-law attorney.

How to Apply

Online: COMPASS portal at compass.dhs.pa.gov (mobile app: myCOMPASS PA).

In person or by mail: the County Assistance Office (CAO) of the county where the applicant resides, Pennsylvania has 67 CAOs, one per county.

By phone: the Consumer Service Center at 1-866-550-4355 began accepting LTC and HCBS applications by phone effective June 16, 2025.

Primary forms

• PA-600, Pennsylvania Application for Benefits (cash, MA, SNAP), main intake form (8/24 revision).
• PA-600 LTC, Long-Term Care supplement for institutional MA.
• PA-1572, Resource Assessment Form (snapshot for CSRA, file promptly at institutionalization).
• PA-162, verification request form.

Processing timelines

• Standard MA: 30 days.
• Disability determination (for under-65 applicants): 90 days.
• LTC with backdating: Up to 3 months retroactive coverage available.

Fair Hearing appeals

If the CAO denies, terminates, or reduces an applicant's MA, the applicant can appeal to the Bureau of Hearings & Appeals (BHA), DHS's administrative tribunal. Authority: 55 Pa. Code Ch. 275.

• Appeal window with notice: 30 days from date of written notice of CAO action.
• Appeal window without notice: 60 days.
• Expedited decisions: Within 30 days for expedited cases.
• Judicial review: Further appeal lies to the Commonwealth Court of Pennsylvania within 30 days of a BHA order.

The 30-day appeal window is significantly shorter than the 60-day window used in many other states (including New York). Applicants who receive a denial notice should engage an attorney within the first 7–10 days to preserve appeal options.

How Pennsylvania Compares to Its Neighbors and Peer States

Where Pennsylvania is more generous than its peers:

• Two-tier asset limit lets low-income applicants keep $8,000 (vs $2,000 in NJ/TX/FL).
• Probate-only estate recovery (vs NJ's expanded recovery).
• Spend-down available through Medically Needy (vs TX/FL income-cap requirement of Miller Trusts).

Where Pennsylvania is less generous than New York:

• NY's $33,038 asset limit dwarfs PA's $2,400/$8,000 two-tier.
• NY's $1,130,000 home equity exemption far exceeds PA's $752,000.
• NY has the Pooled Income Trust pathway under § 1396p(d)(4)(C); PA does not have a comparable mechanism.
• NY has Spousal Refusal under SSL § 366(3)(a); PA does not.

Where Pennsylvania matches Michigan most closely:

• Same $60 PNA, same probate-only recovery, both Medically Needy states with adult spend-down, similar 5-year lookback methodology. The CHC vs. MI Choice distinction (mandatory vs. voluntary managed-care delivery) is the main structural divergence between the two states' LTSS programs.

9 Common Pitfalls in PA Medical Assistance LTC Applications

1. Confusing the two asset tiers. The most common mistake is assuming $2,400 is always the asset limit. For low-income applicants, $8,000 is the relevant figure. Conversely, a higher-income applicant who exceeds the SIL by $50/month (e.g., $3,032 vs $2,982) drops from the $8,000 to the $2,400 limit, sometimes a small income change has a $5,600 asset-limit consequence.

2. Not filing the PA-1572 promptly. The Resource Assessment Form locks the CSRA snapshot at institutionalization. Filing it 6 months later, after additional spending or asset changes, can disadvantage the community spouse.

3. Missing the 30-day appeal window. Pennsylvania's Fair Hearing window is 30 days from notice, not 60 days as in NY. Applicants who delay engagement of counsel often miss this window.

4. Not understanding that PA permits spend-down without a Miller Trust. Families relocating from Texas or Florida often assume a Miller Trust is required for over-income applicants. In PA, the Medically Needy spend-down pathway is usually simpler.

5. Underestimating the daily penalty divisor. A $30,000 transfer that produces a "couple-month" penalty in another state produces a 71-day penalty in PA. Half-loaf strategies must be calibrated to fractional-day calculations.

6. Forgetting that PA is probate-only. Families who don't understand the probate-only scope of Pennsylvania estate recovery often over-restructure assets unnecessarily. Joint accounts, beneficiary-designated assets, and TOD deeds already pass outside probate and outside recovery.

7. Ignoring the home-equity cap when it applies. For high-equity homes in Bucks/Chester/Montgomery County, the $752,000 cap can be a binding constraint on a sole-occupant institutionalized applicant. The "intent to return" affidavit only postpones the issue.

8. Skipping LIFE evaluation for 55+ applicants. Many families do not realize that LIFE/PACE is an alternative to nursing-facility care for 55+ adults who meet NF level of care but can be safely served in the community. The PA Independent Enrollment Broker (1-877-550-4227) handles enrollment.

9. Not coordinating CHC enrollment. When a CHC-eligible Pennsylvanian (21+, dual-eligible) is approved for MA, they are enrolled in a CHC plan. Choosing the right CHC MCO based on existing PCP, hospital, and specialist relationships is consequential, switching is permitted at annual open enrollment or with cause anytime, but the initial choice matters.

Where to Get Help

• PA Department of Human Services, Consumer Service Center 1-866-550-4355
• PA Independent Enrollment Broker (CHC and LIFE enrollment) 1-877-550-4227
• DHS Estate Recovery (800) 528-3708 / RA-PWESTATERECOVERY@pa.gov
• Pennsylvania Health Law Project (PHLP), Helpline 1-800-274-3258 (free legal assistance for MA applicants and recipients)
• Pennsylvania Bar Association Lawyer Referral 1-800-692-7375
• PA Department of Aging APPRISE (free Medicare/MA counseling) 1-800-783-7067
• Local Area Agency on Aging, 52 PA AAAs covering all 67 counties; locate via aging.pa.gov

For complex cases, significant non-probate planning, half-loaf strategies, hardship waivers, CSRA disputes, Fair Hearings, equity-cap issues, engage a Pennsylvania elder-law attorney. The National Academy of Elder Law Attorneys (NAELA) maintains a Pennsylvania chapter with a member directory; the PA Bar Association's Elder Law Section also provides a referral service.

Learn More

• Pennsylvania Medicaid Programs Overview
• How to Apply for Pennsylvania Medicaid
• Pennsylvania Community HealthChoices
• Pennsylvania Medicaid Estate Recovery
• Pennsylvania Spousal Impoverishment
• PA Penalty Divisor & 5-Year Lookback

Find personalized help with Pennsylvania Medicaid eligibility at brevy.com.

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.