Your dad has been in a nursing home outside Pittsburgh for a few months, and his savings are going fast. The business office hands you a thick form called the PA 600 L and mentions the county assistance office. You want to know whether he'll qualify and what happens to the house and to your mom.
This guide uses the Pennsylvania Department of Human Services (DHS) long-term care pages and the Pennsylvania Code, Title 55, Chapter 178. We don't list dollar figures, because they change every year. Instead, we explain how each rule works and point to the official DHS page that lists current amounts. For decisions about property, trusts or gifts, talk with the CAO or a Pennsylvania elder law attorney.
First, the medical need test
Before money matters, your parent must have a medical need for long-term care. A doctor completes a form describing the need, and a department-approved agent reviews it and tells the CAO whether services are needed1. Your parent must also be a Pennsylvania resident, a U.S. citizen or qualified non-citizen, and have a Social Security number1.
The state's Independent Enrollment Broker can schedule an in-person assessment at home, in a hospital or in a nursing facility, and help complete the Medicaid application5. If your parent is coming from a hospital, Medicare may cover a short rehab stay first after a qualifying hospital stay6, which gives the family time to prepare. See when Medicare stops paying for a nursing home.
Income: the two categories
Most income counts, including Social Security, pensions, interest and dividends, rental income and IRA withdrawals1. DHS uses two categories. If your parent's income is at or below 300 percent of the federal SSI benefit rate, they fall into a non-money payment category. If income is above that level, they may still qualify under a medically needy category, where the expected cost of six months of nursing facility care is treated as a medical expense that reduces countable income1. DHS lists the current income figures on its long-term care page.
Being approved doesn't mean your parent's income stays with them. Medicaid pays the difference between the facility's charge for care and your parent's own monthly payment toward that care1. The CAO figures that payment after allowing a small personal needs amount and, for married people, any allowance for the spouse at home. The approval notice shows the amount.
Once approved, most adults 21 or older whose nursing home care Medicaid covers are enrolled in Community HealthChoices (CHC), Pennsylvania's managed care program for people who have both Medicare and Medicaid or who receive long-term services and supports7. The CAO still decides financial eligibility; the CHC plan coordinates your parent's health care coverage7.
Resource limits
Countable resources include bank accounts, stocks, bonds and mutual funds, IRA and Keogh accounts, property other than the home, and the cash value of life insurance above a small threshold1. The resource limit depends on the income category. In the lower income category, the limit is the standard SSI-level amount plus an additional state resource disregard. In the higher income category, a separate, lower combined limit applies1. Check the DHS page for the current amounts.
Some things are excluded. These include one motor vehicle8, burial spaces for your parent and immediate family9, and burial reserves within set limits1. Real estate that isn't the home counts, though your parent gets six months, which can be extended by three months for good cause, to make a real effort to sell it10. Joint bank accounts are divided by each owner's contribution, or equally if there's no proof10.
DHS notes that many people pay privately at first and eventually reduce their resources to the Medicaid limits1. See Medicaid spend-down.
The home
A home your parent lived in before entering a nursing home is excluded if they state in writing that they intend to return, or if a spouse or dependent relative still lives there2. If your parent can't give that statement, a person with legal authority to act for them may give it2.
There's also a home equity limit for long-term care payment, adjusted each year for inflation. It doesn't apply if the home is the residence of a spouse or of a child under 21 or a blind or disabled child, and a hardship waiver is possible3. DHS lists the current figure1. Excluding the home now doesn't settle what happens later. See can a nursing home take your house and Medicaid estate recovery.
When one spouse stays at home
Pennsylvania's spousal impoverishment rules look at everything both spouses own. The spouse at home may keep a spousal share, also called a protected share, equal to half of the couple's countable resources, but no less than a yearly minimum and no more than a yearly maximum111. You can file a Resource Assessment Form (PA 1572) when one spouse enters a nursing facility to find out the share1.
The spouse at home is not required to pay for the other spouse's care and keeps all of their own earnings1. If their income is low, they may receive a community spouse monthly maintenance needs allowance from the nursing home spouse's income. If that isn't enough, extra resources above the protected share can be set aside to produce more income, and in exceptional circumstances a higher allowance can be requested through a hearing1.
The 60-month look-back
The CAO reviews any asset transferred, sold or given away within the past 60 months14. The look-back is set by the date your parent is admitted to a facility and has applied for Medicaid long-term care1.
If fair market value wasn't received, a penalty period follows, during which DHS won't pay for long-term care. It's figured by dividing the uncompensated value by the average daily private pay rate, and it starts on the date your parent would otherwise be eligible14. Federal law allows certain exempt transfers, such as to a spouse12. See the Medicaid look-back period and caregiver agreements with family.
How to apply in Pennsylvania
- Choose how to apply. Apply online through COMPASS, by phone through the DHS Consumer Service Center, or with the paper PA 600 L at the county assistance office51.
- Pick a representative if needed. A spouse, relative, friend, power of attorney or medical provider can complete the form13.
- Gather 60 months of records. Be ready to verify assets owned during the past 60 months, even ones no longer owned13.
- Make sure the medical form is in. The doctor's form and the agent's review confirm the need for care1.
- Watch for a decision. With complete information, the CAO aims to notify you within 30 days whether your parent is eligible, ineligible, or needs to send more13.
- Read the notice carefully. It shows your parent's monthly payment toward care.
For general steps, see how to apply for Medicaid for an elderly parent.
Documents to collect before you apply
- Identity and residence. Proof of identity, citizenship or qualified status, a Pennsylvania address and a Social Security number1.
- Income records. Social Security and pension letters, and statements for any IRA withdrawals.
- Five years of financial statements. Bank and investment accounts for the full look-back13.
- Property and vehicle records. Deeds, tax bills, mortgage statements and vehicle titles.
- Insurance and burial papers. Life insurance policies and any burial contracts.
- Legal authority. Power of attorney or guardianship papers if someone signs for your parent.
An example of how it fits together
Ruth, 84, is widowed and lives in a nursing home in Harrisburg. Her income is a modest Social Security check, and she owns her house. She has spent her savings on care down to just above the limit for her income category, and she bought an irrevocable burial reserve within the allowed limit1.
Her son applies through COMPASS and sends five years of bank statements. Ruth signs a statement that she intends to return home, so the house is excluded, and her equity is under the limit23. She made no gifts in the look-back period4. Once approved, she pays most of her monthly income to the facility, and Medicaid pays the rest1.
This is an illustration, not advice. A spouse at home, a recent gift or a second property would change the result.
Planning carefully, not quickly
Families often hear about trusts, annuities or deeding the house to a child. Federal law allows a few of these steps in narrow situations, such as transfers to a spouse or, in some cases, the home going to a child who provided care that kept a parent out of a nursing home12. Many other moves trigger a penalty period. Because Pennsylvania reviews five full years of records4, a rushed decision can be hard to undo.
Before moving money or property, ask a Pennsylvania elder law attorney or the CAO how the step would be treated. Spending savings on your parent's own care, debts or excluded items like household goods is generally not a transfer, but keep every receipt. If your parent pays a relative for care, put it in a written agreement first, at a fair rate, and keep records of the hours.
Common mistakes Pennsylvania families make
- Assuming high income rules your parent out. The medically needy category can still apply1.
- Gifting before applying. Transfers within 60 months can cause a penalty period4.
- Forgetting the written intent to return. It's how the home stays excluded when no relative lives there2.
- Skipping the PA 1572 for couples. It shows the spousal share early1.
- Letting extra real estate sit. The sale period has limits10.
If the CAO denies coverage or sets an amount you think is wrong, the notice explains how to appeal and request a fair hearing.
Getting help
Your local Area Agency on Aging and the CAO can help with forms. The long-term care ombudsman can help if a facility pressures your parent to leave while an application is pending. See nursing home eviction. For costs in the state, see how to pay for assisted living in Pennsylvania. For other large states, see Ohio, New York, California, Florida and Texas.
