Pennsylvania Medicaid for Senior Care
Complete guide to Medicaid eligibility, coverage, and application process for nursing homes, assisted living, and home care in Pennsylvania.
7.6 million Medicaid long-term care recipients nationwide
Pennsylvania Department of Human Services
Processing Time
45-90 days, 30 days for nursing facility presumptive eligibility
Pennsylvania Medicaid Eligibility Requirements (2026)
To qualify for Medicaid long-term care in Pennsylvania, applicants must meet both financial eligibility criteria (income and assets) and medical criteria (level of care needs). Pennsylvania follows federal Medicaid guidelines with some state-specific variations.
Income Limits
Individual Applicant
$2,982/month (nursing facility)
Married Couple (One Applying)
$2,982/month per applicant
Income includes Social Security, pensions, annuities, interest, dividends, and rental income.
Asset Limits
Individual Applicant
$2,400
Community Spouse (At-Home Spouse)
$152,280 (community spouse)
Primary residence, one vehicle, personal belongings, and prepaid burial arrangements are exempt from asset limits.
5-Year Look-Back Period
Pennsylvania Medicaid reviews all financial transactions for the 60 months prior to application. Asset transfers or gifts during this period can result in a penalty period of Medicaid ineligibility. The penalty is calculated by dividing the transferred amount by $11,200/month average (the average monthly nursing home cost in Pennsylvania).
Medical Eligibility
Applicants must demonstrate need for nursing facility level of care through a state assessment. This typically requires assistance with 2-3 Activities of Daily Living (bathing, dressing, toileting, transferring, eating) or cognitive impairment requiring supervision.
Assessments are performed by state-designated evaluators (nurses or social workers) and typically take 45-90 minutes. The assessment can occur at home, in a hospital, or at the care facility.
What Medicaid Covers in Pennsylvania
Nursing Home Care
Medicaid pays 100% of nursing home costs in Pennsylvania once eligibility is established. The average monthly cost is $11,200/month average. Recipients contribute most of their monthly income toward care costs, keeping only $50-75 for personal needs.
Coverage includes room, board, 24-hour nursing care, meals, medications, therapy services, and all medical care provided at the facility.
Home and Community-Based Services (HCBS) Waivers
Pennsylvania offers 3 HCBS waiver programs that provide in-home care and community services as an alternative to nursing facility placement.
Aging Waiver
Serves adults age 60+ who require nursing facility level of care, providing in-home services to remain in the community.
Program Details →OBRA Waiver
Provides waiver services to individuals in intermediate care facilities for individuals with intellectual disabilities.
Program Details →Community HealthChoices
Managed care program that coordinates Medicaid long-term services and supports with physical health care.
Program Details →How to Apply for Medicaid in Pennsylvania
Pennsylvania Medicaid applications typically take 45-90 days, 30 days for nursing facility presumptive eligibility. Starting the process early and submitting complete documentation helps avoid delays.
Application Methods
You can apply for Medicaid in Pennsylvania through:
- Online through COMPASS
- Mail to County Assistance Office
- In-person at CAO
- Through long-term care facility
Step 1: Gather Required Documents
Before starting your application, collect:
- •Birth certificate and Social Security card
- •Proof of citizenship (passport, naturalization)
- •5 years of bank statements
- •Investment and retirement account statements
- •Property deeds and mortgage statements
- •Life insurance policies
- •Social Security award letter
- •Pension benefit statements
- •Medicare card
- •Doctor's statement of care needs
Step 2: Submit Your Application
Complete and submit your application through one of the methods listed above. If applying online or by mail, keep copies of all submitted documents.
Step 3: Medical Assessment
A state assessor will evaluate level of care needs. This assessment typically takes 45-90 minutes and covers functional abilities, medical needs, cognitive status, and safety concerns.
Step 4: Financial Review
Medicaid staff review all financial documents and investigate any transfers or gifts made in the past 60 months. They may request additional documentation during this process.
Step 5: Receive Determination
You'll receive written notification of approval or denial. Approved applications include the effective date of coverage (often retroactive up to 3 months), patient responsibility amount, and covered services.
Get Free Application Help
Free Medicaid application assistance is available in Pennsylvania from:
- •Area Agency on Aging: Call 1-800-677-1116 (Eldercare Locator) to find your local office
- •SHIP counselors: Free Medicare/Medicaid counseling
- •Nursing facility social workers: In-facility application support
- •Elder law attorneys: Paid help for complex financial situations ($2,000-$5,000)
Pennsylvania-Specific Programs and Resources
OPTIONS Program
Pre-admission consultation and care coordination for individuals entering nursing facilities.
Learn MoreNeed Help with Pennsylvania Medicaid?
Contact Pennsylvania Department of Human Services for specific questions about eligibility, application status, or covered services.
Main Office Phone
1-800-692-7462Application Helpline
1-866-550-4355