How to Apply for Medicaid in Pennsylvania

You can apply for Medicaid online by clicking here.  You can also submit a paper application, which you can find on the state website (here), or get assistance applying via an attorney.

Medicaid Eligibility Program Overview

Medicaid pays for the cost of Nursing Home care in Pennsylvania that meets certain financial and health criteria.  The average cost of Skilled Nursing Care in Pennsylvania is $129,360 per year, so securing Medicaid coverage is essential.  There are 680 nursing homes in Pennsylvania, most of which accept Medicaid insurance as a form of payment.  Pennsylvania nursing homes are currently 74.5% occupied, with an average of 64,525 patients using 86,590 available beds.

Pennsylvania Medicaid Asset Limitations for 2023

Individuals in Pennsylvania can keep $2,000 when they apply to Medicaid for long-term care.  If they are over this amount, they must spend down on care.  It’s important to note that individuals are not allowed to give gifts of any amount for a period of 5 years (60 months) before applying for Medicaid.  If an individual’s assets are more than $2,000, they should learn about Medicaid Planning strategies.  This asset limit only applies to assets that are considered countable.  Countable assets include; savings accounts, checking accounts, retirement accounts and a second home.  If you have multiple assets and are looking to access Medicaid, it may make sense to speak with a Medicaid Planner or Elder Law attorney in Pennsylvania.

Couples that both require Medicaid for long-term care in Pennsylvania are allowed to keep $0 in assets.  If one spouse requires care and one does not, the spouse that does not receive care is known as the Community Spouse.  The Community Spouse is allowed to keep 50% of their assets up to $123,600 in countable assets, which is known as the Community Spouse Resource Allowance.  The Community Spouse is allowed to keep 100% of their marital assets up to $24,720.

The maximum amount of home equity allowed when applying to Medicaid is $572,000.  Despite the fact that the home is not a countable asset, Medicaid can look for repayment in probate court from the sale proceeds after it stops paying for care.  It is important to understand if your home may be subject to the Medicaid repayment process.

Income Limits in Pennsylvania For Medicaid

Unfortunately, a Miller Trust, also known as a Qualified Income Trust, is not available to residents of Pennsylvania.  If an individual is married, the spouse’s income does not typically count towards the income cap, but it is important to maximize income protection via the Monthly Needs Allowance rules.  The maximum amount of income the Medicaid office allows a community spouse to keep in Pennsylvania is $3,023.  All of an individual’s monthly income must go towards their cost of care, which can include medical bills, prescriptions and other health care costs.  $45 can be set aside for the personal needs allowance.  The income limits are based on a percentage of the Supplemental Security Income defined by the Social Security Administration’s Federal Poverty Levels (FPL) and change annually.

Penalty Information in Pennsylvania For Medicaid

If a gift of any amount is given in Pennsylvania during a period of 5 years before applying to Medicaid, a penalty period will be initiated. This penalty period in Pennsylvania is called a look-back period, which can make an individual not eligible for Medicaid.   Medicaid will not pay for care until the penalty period is over.  The penalty is calculated by taking the total amount of any gifts given and dividing it by $9,792, which creates a several-month period before Medicaid coverage begins.

The average cost of Nursing home care (private room) in Pennsylvania is $11,157, so penalties can become very costly for a family that has not planned appropriately for Medicaid.

Medicaid Waiver in Pennsylvania