Pennsylvania Medicaid, officially called Medical Assistance (MA), pays for long-term nursing and home care through a 300% SSI income limit of $2,982 per month in 2026, a two-tier asset limit, and probate-only estate recovery that reaches only assets passing through the probate estate.

Pennsylvania Medicaid is administered by the Pennsylvania Department of Human Services (DHS), which handles both financial eligibility and program administration for older adults and people with disabilities. Long-term services and supports run through Community HealthChoices (CHC), the state's mandatory managed care program for dual eligibles and people with physical disabilities. This guide maps every key question about Pennsylvania Medicaid to the dedicated article that answers it.

What Pennsylvania Medicaid Covers

Pennsylvania Medical Assistance covers the mandatory federal benefit categories plus a set of state-elected optional services:

  • Hospital care: Inpatient and outpatient services
  • Physician, clinic, and specialist visits
  • Prescription drugs through the Medical Assistance pharmacy benefit
  • Behavioral health: Mental health and substance use disorder services, delivered through separate HealthChoices behavioral-health managed care plans
  • Home health: Skilled nursing visits and home health aide services
  • Long-term care: Nursing facility coverage and home and community-based services (HCBS), delivered through Community HealthChoices for people who meet the nursing-facility level-of-care standard
  • Medicare Savings Programs (MSPs): Premium and cost-sharing assistance for dual-eligible beneficiaries, branded in Pennsylvania as Healthy Horizons
  • Non-emergency medical transportation (NEMT)

For older adults and people with disabilities, long-term care coverage is the most financially significant benefit. In Pennsylvania, a semi-private nursing home room runs about $143,445 per year and a private room about $164,250 per year, each priced on 365 days of care, according to the CareScout 2025 Cost of Care Survey. Medical Assistance covers the cost once a resident meets financial and clinical eligibility standards.

Who Qualifies for Pennsylvania Medicaid

Pennsylvania Medicaid Eligibility Overview

Pennsylvania covers several population groups under Medical Assistance. For seniors and people with disabilities needing long-term services, eligibility runs through the aged, blind, and disabled categories. The key financial parameters for a single long-term-care applicant in 2026:

  • Income limit: $2,982/month, equal to 300% of the 2026 SSI Federal Benefit Rate of $994. This is the Special Income Limit for the non-money-payment (NMP) long-term-care categories.
  • Asset limit (two-tier): $8,000 ($2,000 federal base plus a $6,000 Pennsylvania resource disregard) when income is at or below $2,982/month, and $2,400 when income exceeds $2,982/month. Countable assets exclude the primary home, one vehicle, household goods, and prepaid burial.
  • Home equity limit: The 2026 limit is $752,000 unless the state elects a higher amount, up to $1,130,000. The cap does not apply at all when the applicant's spouse, a child under 21, or a blind or permanently and totally disabled child of any age is lawfully residing in the home, and the home is then exempt regardless of its equity.
  • Look-back period: 60 months (five years) on uncompensated asset transfers.

Pennsylvania is a medically-needy state, so an applicant whose income exceeds the Special Income Limit can still qualify by spending down through incurred medical expenses rather than establishing a trust. For full details on income limits, asset rules, and all eligibility categories, see Pennsylvania Medicaid Eligibility and Income Limits.

The Two-Tier Asset Limit

Pennsylvania's two-tier asset limit is a structurally distinctive feature. Most states apply a single fixed asset limit; Pennsylvania applies two, depending on where the applicant's income falls relative to the Special Income Limit.

  • Tier One: $8,000. Applies when the applicant's gross monthly income is at or below the Special Income Limit ($2,982/month). The $8,000 equals a $2,000 federal base plus a $6,000 Pennsylvania resource disregard. Pennsylvania publishes those two pieces separately rather than a single combined $8,000 figure, so a caseworker's paperwork will show the $2,000 limit and the $6,000 disregard on their own lines.
  • Tier Two: $2,400. Applies when the applicant's income exceeds the Special Income Limit.

An applicant with $2,800/month in income and $7,500 in countable assets qualifies under Tier One ($8,000). The same applicant with $3,200/month in income falls under Tier Two ($2,400) and must use the medically-needy spend-down pathway, where the medically-needy-only resource limit is $2,400 for one person and $3,200 for two.

For worked examples, see Pennsylvania Medicaid Eligibility and Income Limits.

Medically Needy Spend-Down (No Miller Trust Required)

Pennsylvania is a medically-needy state: it elected the optional medically-needy (MNO-MA) category under federal law, so an aged, blind, or disabled applicant whose countable income exceeds the categorical income standard can still qualify by incurring medical expenses. This matters because income-cap states such as Texas and Florida instead require an over-limit applicant to establish a Qualified Income Trust (Miller Trust) to qualify. Pennsylvania does not.

How the Pennsylvania spend-down works:

  • An applicant's income exceeds the Special Income Limit ($2,982/month).
  • The applicant submits incurred medical expenses (nursing-facility per-diems, hospital balances, prescription co-pays, home-care services, Medicare premiums, and similar costs).
  • Pennsylvania computes the spend-down over a six-month (semi-annual) budget period. The Medically Needy Income Limit (MNIL) is $2,550 on a semi-annual net-income basis for a single person.
  • Once verified expenses bring net income to or below the MNIL, Medical Assistance covers the rest of the cycle.

For a nursing-facility resident, two months of private-pay per-diem typically far exceeds the six-month spend-down threshold, so institutional applicants usually clear the spend-down quickly. A family that paid to set up a Miller Trust in Texas or Florida may move to Pennsylvania and find the trust unnecessary.

For the full spend-down mechanics, see Pennsylvania Medically Needy Spend-Down.

The 5-Year Lookback and Penalty Divisor

Pennsylvania applies the federal 60-month (five-year) look-back to asset transfers made for less than fair market value before a long-term-care application, under 42 U.S.C. 1396p(c). Uncompensated transfers within that window generate a penalty period of Medical Assistance ineligibility.

Pennsylvania's penalty divisor is structurally distinctive: it is a daily divisor of $421.20 per day effective January 1, 2026 (equivalent to $12,811.50 per month), while most states use a monthly divisor with whole-month rounding. Because Pennsylvania divides by a daily figure, the resulting penalty period is measured in days rather than rounded to whole months. The divisor is the Commonwealth's average private-pay nursing-facility rate, which the Department of Human Services publishes in Chapter 440 Appendix A of its Long-Term Care Handbook; the prior rate, effective January 1, 2025, was $399.80 per day.

Which year's rate applies is easy to get wrong. It is not the rate on the day you filed: DHS instructs county assistance offices to use the rate in effect when the period of ineligibility is determined, and to apply that determination-date rate even when they are authorizing retroactive coverage for a period governed by a different rate (55 Pa. Code 178.104a(e) and Handbook 440.85). The regulation's applicant-facing wording at 55 Pa. Code 178.104a(d) puts it as the rate in effect when the application is processed.

To calculate a penalty, divide the uncompensated transfer amount by $421.20. A $30,000 gift produces about 71 days of ineligibility ($30,000 divided by $421.20). The penalty reaches only transfers made within the federal 60-month look-back, and an undue-hardship waiver is available where the penalty would deprive the applicant of medical care or the necessities of life.,

For exempt-transfer rules and hardship-waiver mechanics, see Pennsylvania Penalty Divisor and 5-Year Lookback.

Spousal Impoverishment Protections

When one spouse applies for Pennsylvania Medical Assistance long-term-care coverage and the other does not, federal spousal impoverishment protections keep the community spouse from losing all of the couple's shared resources.

Key 2026 figures:

  • Community Spouse Resource Allowance (CSRA): The community spouse keeps one-half of the couple's countable resources, no less than the federal floor of $32,532 and no more than the federal maximum of $162,660.
  • Minimum Monthly Maintenance Needs Allowance (MMMNA): $2,705.00/month (effective July 1, 2026 through June 30, 2027), rising to a maximum Monthly Maintenance Needs Allowance of $4,066.50/month for 2026.
  • Home: Exempt from the eligibility calculation while the community spouse lives there.

The community spouse's own income is protected under the "name on the check" rule: only the Medical Assistance applicant's income flows toward the nursing-facility cost. For how the snapshot process and income diversion work, see Pennsylvania Medicaid Spousal Impoverishment.

Long-Term Care: Nursing Home Medical Assistance

For coverage in a Medicaid-certified nursing facility, Pennsylvania requires an applicant to meet four tests: the income test (at or below the Special Income Limit, or the medically-needy spend-down pathway), the applicable asset-limit tier, the nursing-facility level-of-care standard, and the 60-month look-back review.

Once eligible, the resident contributes nearly all monthly income toward the nursing-facility cost, keeping only the $60 Personal Needs Allowance, plus deductions for Medicare premiums and, where applicable, the community-spouse income allowance. A private-pay nursing-home room in Pennsylvania runs about $164,250 per year and a semi-private room about $143,445 per year, each priced on 365 days of care, per the CareScout 2025 Cost of Care Survey; Medicaid-certified facilities accept the lower Medicaid rate once a resident qualifies.

For the full nursing-home Medical Assistance walkthrough, see Pennsylvania Nursing Home Medicaid.

Estate Recovery (Probate-Only)

Pennsylvania is one of the more consumer-friendly estate-recovery states because it recovers only against the probate estate. After the death of a recipient age 55 or older who received long-term-care Medical Assistance (nursing facility, HCBS, and related hospital and prescription services) on or after August 15, 1994, Pennsylvania pursues recovery under 62 P.S. 1412 and 55 Pa. Code Chapter 258. It has not adopted the federal expanded-recovery option.

Because recovery reaches only the probate estate, assets that pass outside probate are not subject to the claim: joint tenancy with right of survivorship, tenancy by the entireties, payable-on-death and transfer-on-death accounts, beneficiary-designated retirement accounts, life insurance and annuities with named beneficiaries, and assets in a qualifying pre-death trust. Pennsylvania permanently waives its claim for administered estates with a gross value of $2,400 or less when there is an heir, and it grants undue-hardship waivers. Recovery is postponed while a surviving spouse is living, while a surviving child is under 21 or is blind or permanently and totally disabled, and while a sibling with an equity interest who lived in the home for at least one year before death remains there.

For the full rules and hardship process, see Pennsylvania Medical Assistance Estate Recovery.

Community HealthChoices (CHC)

Community HealthChoices is Pennsylvania's mandatory Medicaid managed care program for dual eligibles and people with physical disabilities, and it is how the Department of Human Services Office of Long-Term Living administers managed long-term services and supports. Enrollment is not simply a matter of meeting the nursing-facility level of care. A person may be enrolled if they are 21 or older and are receiving both Medicare and Medicaid, receiving long-term services and supports through the Attendant Care, Independence, COMMCARE, or Aging waivers, receiving OBRA waiver services and found nursing-facility clinically eligible, receiving nursing-home care paid for by Medicaid, or participating in Act 150 while dually eligible.

CHC covers acute physical health care, HCBS waiver services, and nursing-facility care through a single managed care plan; behavioral health is carved out to separate HealthChoices behavioral-health plans. The program is organized into five zones, and each zone is covered by all three CHC managed care organizations: AmeriHealth Caritas, PA Health & Wellness, and UPMC Community HealthChoices.

For the plan-by-plan comparison and HCBS service descriptions, see Pennsylvania Community HealthChoices.

LIFE Program (Pennsylvania PACE)

The LIFE program (Living Independence For the Elderly) is Pennsylvania's version of the federal Program of All-Inclusive Care for the Elderly (PACE). LIFE delivers comprehensive primary, preventive, acute, and long-term care through an interdisciplinary team so that eligible seniors can remain in the community rather than a nursing facility.

Federal PACE rules set three substantive enrollment requirements at 42 CFR 460.150(b): be age 55 or older, be determined by the state administering agency to need the level of care its Medicaid plan requires for nursing-facility services, and reside in the PACE organization's service area. A fourth lets the PACE program agreement add its own conditions, but those may not modify the first three. A separate requirement at 42 CFR 460.150(c)(1) is that at the time of enrollment the person must be able to live in a community setting without jeopardizing their health or safety. Enrollment is not restricted to Medicare or Medicaid beneficiaries, so a person may also join and pay privately.

In Pennsylvania, a person 55 or older who meets a skilled-nursing or special-rehabilitation level of care, meets the financial requirements, and lives in an area a LIFE provider serves may choose LIFE instead of Community HealthChoices. For a participant who qualifies for Medicaid, the PACE organization may not charge a monthly premium and must take the Medicaid capitation as payment in full, with the only permitted exceptions being any Medicaid spend-down liability and amounts owed under post-eligibility treatment of income. For the enrollment process and a LIFE-versus-CHC comparison, see Pennsylvania LIFE Program.

Healthy Horizons: Medicare Savings Programs

Healthy Horizons is Pennsylvania's branding for the Medicare Savings Programs (MSPs), which help low-income Medicare beneficiaries pay Medicare costs. Three of the four matter most to retired beneficiaries and are set out below. The fourth, Qualified Disabled and Working Individual (QDWI), pays the Part A premium for certain working people with disabilities who lost premium-free Part A, and it does not carry Extra Help.

Program What It Covers 2026 Income Limit (Single)
QMB (Qualified Medicare Beneficiary) Part A and Part B premiums plus all Medicare deductibles, coinsurance, and copays About $1,350/month
SLMB (Specified Low-Income Medicare Beneficiary) Part B premium only About $1,616/month
QI (Qualifying Individual) Part B premium only About $1,816/month

Resource limit for all three: $9,950 for one person, $14,910 for a couple.

QI carries three conditions the other two do not: it is paid from a limited annual allocation and granted first come, first served, you must reapply for it every year, and you cannot hold QI and full Medicaid at the same time. So a Pennsylvanian who qualifies for full Medical Assistance is served by QMB or SLMB, not QI.

Enrolling in QMB, SLMB, or QI automatically qualifies a beneficiary for Extra Help (the Part D Low-Income Subsidy). Federal law also bars providers from billing a QMB enrollee for Medicare cost-sharing. The income figures above are the federal ones and already include the $20 SSI general income exclusion; a state may disregard additional income or resources, so apply even if you land slightly over on either.

See Pennsylvania Medicare Savings Programs for the Healthy Horizons walkthrough.

How to Apply for Pennsylvania Medicaid

Applying for Pennsylvania long-term-care Medical Assistance follows a defined sequence. Gather your paperwork first, then apply through one of the state's channels.

1
Step 1

Gather your documents

Collect income statements, asset and bank records covering the full 60-month look-back period, proof of citizenship and Pennsylvania residency, insurance cards, and any trust paperwork. Long-term-care applications are document-heavy, and missing records are the most common cause of delay.

2
Step 2

Apply online, by mail, or by phone

Apply online through COMPASS at compass.state.pa.us, in person or by mail through your County Assistance Office (using Form PA-600, plus PA-600 LTC for nursing-facility applications), or by phone at the Consumer Service Center at 1-866-550-4355.

3
Step 3

Complete the level-of-care screening

Long-term-care applicants receive a clinical nursing-facility level-of-care assessment in addition to the financial eligibility review.

4
Step 4

Respond to any requests and await the decision

Standard processing is 30 days for non-disability Medical Assistance and up to 90 days when a disability determination is required. Reply promptly to any request for verification.

5
Step 5

Appeal if you disagree. Pennsylvania's deadline is 30 days, not 90

Under 55 Pa. Code 275.3(b)(1) you have 30 days from the date of the written notice to request a fair hearing before the Bureau of Hearings and Appeals. It stretches to 60 days where no written notice was required, and to 6 months where the required notice of the action and of your appeal rights was never sent. The 90 days in 42 CFR 431.221(d) is the ceiling on what a state may allow, not time Pennsylvania gives you, so pacing yourself against it forfeits the appeal. The appeal must be in writing, filed with the office that took the action, usually your County Assistance Office, which forwards it to the Bureau. A phone call does not preserve it.

If Medical Assistance you already have is being cut or ended, a second and earlier deadline decides whether coverage keeps flowing. Under 55 Pa. Code 275.4, benefits continue until the hearing decision only when you file within the advance-notice period, meaning before the effective date printed on the notice, which usually falls well inside the 30-day filing window. A Community HealthChoices participant challenging a plan's service decision follows a separate track, completing the plan's Complaint or Grievance first and then requesting a hearing within 120 days of the mail date on the plan's decision. That 120 days belongs to the plan path and is not the deadline for an eligibility denial.

For a full walkthrough and document checklist, see How to Apply for Pennsylvania Medicaid.

Keeping Pennsylvania Medicaid Once You Have It

Missing a renewal is one of the most common ways people lose coverage they still qualify for, and federal rules put most of the work on the agency rather than on you. Before it asks you for anything, Pennsylvania Medicaid must first try to renew your coverage automatically from information it already holds, and may only request documents if it cannot. If it does need paperwork, it must send a renewal form and give you at least 30 days from the date on that form to return it. That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Pennsylvania may offer the same windows but is not required to, so ask your County Assistance Office what applies to you.

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise). So a MAGI-based renewal missed by a few weeks is usually recoverable, provided you act.

Return a renewal form the week it arrives. See Pennsylvania Medicaid Recertification and Renewal for the full cycle and how to recover coverage that has already closed.

Where to Get Help

Pennsylvania Department of Human Services (DHS) Administers Medical Assistance eligibility, long-term care, and Community HealthChoices; answers program questions. 1-866-550-4355 pa.gov/agencies/dhs
COMPASS Online Application Portal Apply online for Medical Assistance and other benefits in a single submission. compass.state.pa.us
County Assistance Office (CAO) Handles application intake, resource assessments, and eligibility determinations for each Pennsylvania county. pa.gov/agencies/dhs/resources/find-your-cao

Pennsylvania Medicaid FAQ

Frequently Asked Questions

What is the income limit for Pennsylvania Medicaid in 2026?

$2,982 per month for a single long-term-care applicant, equal to 300% of the 2026 SSI Federal Benefit Rate. An applicant whose income exceeds this limit does not need a trust; Pennsylvania is a medically-needy state and allows the applicant to spend down through incurred medical expenses instead.

Is Pennsylvania a Miller Trust state?

No. Pennsylvania is a medically-needy state, so an applicant whose income exceeds the $2,982 Special Income Limit can qualify by spending down income through incurred medical expenses, rather than establishing a Qualified Income Trust (Miller Trust) the way applicants in income-cap states such as Texas and Florida must.

What is the asset limit for Pennsylvania Medicaid?

Pennsylvania uses a two-tier limit for a single long-term-care applicant: $8,000 ($2,000 base plus a $6,000 Pennsylvania disregard) when income is at or below $2,982/month, and $2,400 when income exceeds $2,982/month. Countable assets exclude the primary home, one vehicle, household goods, and prepaid burial.

Will Pennsylvania Medicaid take my parent's house after they pass?

Pennsylvania pursues estate recovery only against the probate estate of a recipient age 55 or older who received long-term-care Medical Assistance. Assets that pass outside probate, such as joint tenancy, beneficiary-designated accounts, and life insurance, are not subject to the claim, and a surviving spouse or a surviving child who is under 21 or disabled postpones recovery. See Pennsylvania Medical Assistance Estate Recovery for details.

How does the community spouse protection work in Pennsylvania?

The community spouse keeps one-half of the couple's countable resources, no less than $32,532 and no more than the federal maximum of $162,660, plus all of their own income. If the community spouse's income falls below $2,705.00 per month, a portion of the applicant's income can be diverted to bring them up to that floor. See Pennsylvania Medicaid Spousal Impoverishment for the full framework.

Learn More

MedicaidMedicaid by State: Eligibility, Coverage, and How to ApplyMedicaid works differently in every state, from who qualifies to what's covered and how to apply. See what varies and jump to your state's full guide. MedicaidPennsylvania Medicaid Eligibility and Income LimitsPennsylvania Medicaid income limits for 2026: the $2,982 long-term-care income cap, the two-tier $2,400/$8,000 asset limit, and how seniors qualify. MedicaidHow to Apply for Pennsylvania MedicaidHow to apply for Medicaid in Pennsylvania in 2026: COMPASS online, the County Assistance Office, or the new phone line, plus PA-600/600 LTC forms and timelines. MedicaidPennsylvania Medically Needy Spend-DownHow Medicaid Pennsylvania medically needy spend-down works in 2026: the MNIL, six-month cycle, eligible bills, and the Miller Trust comparison. MedicaidPennsylvania Penalty Divisor and 5-Year LookbackMedicaid Pennsylvania penalty divisor and lookback in 2026: PA's $421.20/day divisor, 60-month lookback, exempt transfers, and the half-loaf strategy. MedicaidPennsylvania Medical Assistance Estate RecoveryHow Pennsylvania Medicaid estate recovery works in 2026: probate-only scope, the $2,400 small-estate waiver, postponement rules, and hardship waivers. MedicaidPennsylvania Medicaid Spousal ImpoverishmentMedicaid Pennsylvania spousal impoverishment in 2026: CSRA $162,660 cap, MMNA $4,066.50 max, PA-1572 snapshot, and PA's income-first methodology. MedicaidPennsylvania Community HealthChoicesHow Community HealthChoices works in Pennsylvania in 2026: the three CHC plans, who must enroll, the carve-outs, Services My Way, and how to choose a plan. MedicaidPennsylvania LIFE ProgramHow the LIFE Program Pennsylvania works in 2026: PACE eligibility, day-center care, costs, the PA provider footprint, and how it compares with CHC. MedicaidPennsylvania Medicare Savings ProgramsPennsylvania Medicare Savings Programs 2026: QMB, SLMB, and QI income limits, what each pays, Part D Extra Help, and how to apply through COMPASS or a CAO. MedicaidPennsylvania Nursing Home MedicaidDoes Pennsylvania Medicaid pay for a nursing home? A 2026 guide to Pennsylvania Medicaid nursing home coverage, eligibility, patient pay, and estate recovery.

Find personalized help with Pennsylvania Medicaid programs 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.

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