Pennsylvania Medicaid Long-Term Care Eligibility and Coverage

The Medicaid system isn’t always easy to navigate, and it's common to feel unsure about where to begin. Whether you are seeking coverage for yourself or supporting a senior in Pennsylvania, this guide, from Senior Planning, explains the essentials of Pennsylvania’s long-term care Medicaid, including eligibility requirements, the types of programs available, and the steps to take to ensure you qualify for the coverage you need.

Pennsylvania Medicaid Eligibility Requirements 2025

Who qualifies for Medicaid in Pennsylvania?

For long-term care Medicaid services in Pennsylvania, individuals must be 65 years old or older, U.S. citizens, residents of Pennsylvania, and meet the income and asset requirements. 

The thresholds for income and assets will vary based on marital status and the selected Medicaid program. These numbers may be subject to change.

Pennsylvania Medicaid Income Limits

The following Medicaid eligibility income chart for Pennsylvania outlines the income limits for seniors seeking Medicaid based on the long-term services they are applying for.

Medicaid considers various sources of income in its calculations, such as wages from employment, alimony, Social Security benefits, and pension payments. However, the VA Aid and Attendance benefit is not regarded as a countable asset in Pennsylvania.

When only one spouse applies for Institutional Medicaid or Home and Community-Based Services, eligibility is based on the applying spouse’s income. In these cases, the non-applicant spouse may receive a Minimum Monthly Maintenance Needs Allowance (MMMNA) for additional support. The current MMMNA is $2,555 per month. If the non-applicant’s income falls below this amount, the applicant can transfer enough income to reach that threshold, and in some situations, the Spousal Income Allowance can be increased if housing and utility expenses are higher.

For Regular Medicaid, however, both spouses’ incomes are considered when determining eligibility, and there is no income allowance for the non-applicant spouse.

Pennsylvania Medicaid Asset Limits 2025

The asset limit is another crucial aspect in determining Pennsylvania Medicaid long-term care eligibility. These limits are outlined in the table below.

Assets that are counted in the Medicaid limit include cash, investments, bank accounts, and additional property. Assets that are not included are the home you or your spouse is living in, personal items, household furnishings, and one vehicle. 

For a married couple, Medicaid treats all assets as jointly owned. However, if only one spouse applies for long-term care Medicaid under the Nursing Home Program or HCBS, the non-applicant spouse may keep up to $157,920 of the couple's assets under the Community Spouse Resource Allowance (CSRA). This allowance does not apply to Regular Medicaid.

Look-Back Rule: Pennsylvania has a 5-year (60 months) look-back period for long-term care. Any transfers of assets below fair market value during this time can result in a penalty period where you are temporarily prevented from receiving benefits. Regular Medicaid has no look-back period.

How to Qualify if You Exceed the Limits

You may still be able to qualify for Medicaid in Pennsylvania even if you do not meet the income or asset limit.  Pennsylvania allows for specific legal and financial strategies to spend down income and protect one’s assets.

Medically Needy Pathway

Pennsylvania’s Medically Needy Program allows individuals with income above the Medicaid limit to qualify by spending most of their income on medical expenses. In 2025, the income limit is $425 per month for singles and $442 per month for couples, with an asset limit of $2,400 for singles and $3,200 for couples. Once the monthly “spend-down” amount is met, you can qualify for long-term Medicaid services.

Medicaid Spend Down in Pennsylvania

If your assets exceed the Medicaid set limit, you may still be able to qualify by “spending down” additional assets on non-countable ones, such as home modifications, paying off debt, or prearranged burial expenses.

How to Apply for Medicaid in Pennsylvania for The Elderly

It can feel like a lot to oversee the various Medicaid rules and application process. But you don’t have to do it alone. At Senior Planning, we are here to guide you and make this process smoother and more manageable. Here are some of the steps for applying:

1. Choose the Right Medicaid Program: Medicaid offers several programs for seniors’ long-term care, including Nursing Home Medicaid, Home and Community-Based Services, or Regular Medicaid.

2. Check Eligibility Requirements: Review the Pennsylvania Medicaid eligibility requirements for your chosen program, including income and asset limits, to ensure you qualify.

3. Gather Documentation Required for Medicaid in Pennsylvania: Prepare the necessary paperwork to verify your eligibility. Some of these documents include:

   1. 1. A valid identification document (like a driver's licence or government ID)

      2. Social Security card

      3. Bank statements

      4. Proof of income and assets

      5. Health insurance cards

      6. Medical records 

      7. Check out our complete Medicaid document checklist to learn more.

4. Complete the Application: Fill out the Medicaid application online at COMPASS or submit a paper version via your local County Assistance Office (CAO).

Medicaid Nursing Home Eligibility in Pennsylvania

How much does Medicaid pay for a nursing home in Pennsylvania? 

Although Medicaid is not accepted by every nursing home in Pennsylvania, it does fully cover nursing home care for seniors who qualify. This includes room and board, meals, and standard medical services. Keep in mind that some facilities offer only a limited number of Medicaid beds or may give preference to private-pay residents, so it is important to check with each nursing home about its current Medicaid availability.

Medicaid for Assisted Living in Pennsylvania

How much will Medicaid pay for assisted living in Pennsylvania? 

Medicaid provides seniors access to long-term care services in assisted living setups. This includes medical support, personal care, and other daily assistance. There are multiple programs designed to help individuals receive the care they need without depleting their savings. 

Pennsylvania Medicaid Long-Term Care Eligibility Support

Senior Planning is here to help you navigate Pennsylvania’s long-term care Medicaid application process. We support seniors and their families from start to finish, making sure you or your loved one can access the care you deserve. Reach out to Senior Planning today to begin the process.

Frequently Asked Questions about Pennsylvania Medicaid Eligibility

Does Medicaid in Pennsylvania count a home towards the asset limit?

In general, the applicant's primary home is not counted towards the set Medicaid asset limit in Pennsylvania. However, if neither spouse lives in the home, the home equity interest limit is $730,000. This is calculated by subtracting any outstanding debts from the house's value. Additionally, the home may not be exempt from Medicaid’s Estate Recovery Program, under which the estate is used to reimburse care costs after the beneficiary's death. 

How do I apply for Medicaid online in Pennsylvania?

You can apply for Pennsylvania Medicaid online via COMPASS. This website is Pennsylvania’s online system for applying and managing a range of public assistance programs, including helping seniors apply for long-term care. 

Are there Pennsylvania Medicaid eligibility changes in 2025 for seniors?

Yes, Pennsylvania introduced Medicaid eligibility changes in 2025 for seniors. Pennsylvania expanded access by easing asset tests for long-term care, improving automated renewals, and aligning rules with federal guidelines. Seniors saw simpler recertification processes and more consistent eligibility decisions across Medicaid and waiver programs.

Does Pennsylvania require repayment of Medicaid benefits?

Yes, Pennsylvania requires repayment of Medicaid benefits through Estate Recovery. Pennsylvania recovers costs for individuals 55 or older who received long-term care services, including nursing home care, home- and community-based services, and related medical costs. Repayment occurs after death and applies only to assets in the estate.