Medicaid for Senior Care in Pennsylvania
What Medicaid Actually Covers for Senior Care
Navigating senior care in Pennsylvania with Medicaid, known locally as Medical Assistance, primarily involves the Community HealthChoices (CHC) Program. This managed care program is for Pennsylvanians age 21 and older who are eligible for both Medicare and Medicaid, or who need a nursing facility level of care. CHC replaced previous waivers, including the Department of Aging Waiver, and covers a wide range of long-term services and supports (LTSS) to help your loved one stay at home or in a community setting.
Through CHC, services can include personal assistance, home health aides, various therapies (physical, occupational, speech), home modifications, specialized medical equipment, adult daily living services, and even home-delivered meals. If nursing home care is needed, Institutional/Nursing Home Medicaid covers the full cost, including room, board, and medical services. However, a key gap to remember is that while CHC supports care in assisted living or personal care homes, it typically does not cover room and board costs in those settings.
Do You Qualify?
The eligibility picture for 2026 has specific financial requirements. For a single senior applying for Nursing Home Medicaid or the CHC Waiver, the monthly income limit is $2,982. The asset limit for these programs is generally $8,000, though it can be $2,400 if monthly income exceeds $2,982. For basic Aged, Blind, and Disabled (ABD) Medicaid, a single applicant's asset limit is $2,000.
If your parent's income is above these limits, Pennsylvania has a "Medically Needy Only" (MNO-MA) or "spend-down" program. This allows them to become income-eligible by using excess income on medical expenses, like nursing home bills, over a six-month period. Assets over the limit can also be "spent down" on approved items like paying off debt or home modifications.
What if your parent owns a house? Their primary residence is usually exempt if they, a spouse, or a minor or disabled child lives there. If no qualifying family member resides there, a home equity limit of $752,000 applies for 2026. Be aware that while the home is protected during their lifetime, Pennsylvania's Medicaid Estate Recovery Program may seek reimbursement from the estate after death. If your parent has a pension, this income is counted towards the limit. For married couples where only one spouse needs care, spousal impoverishment rules allow the non-applicant spouse to keep a significant portion of assets, up to $162,660 in 2026, and their home. Pennsylvania also has a five-year "look-back" period for asset transfers, so any gifts or transfers made within this timeframe could result in a penalty period.
Waitlists & How to Apply
Good news: There is generally no waitlist for Nursing Home Medicaid itself, as it's an entitlement. However, specific nursing facilities may have their own waitlists for beds. For Home and Community-Based Services (HCBS) waivers like CHC, while the program aims to avoid waitlists for enrollment, there can sometimes be limitations on the availability of specific services.
To apply for Medicaid long-term care in Pennsylvania, you have several options. You can apply online through the state's COMPASS website (www.compass.state.pa.us). You can also call the Health Care Coverage Consumer Service Center at 1-866-550-4355, or for CHC specifically, reach out to the Independent Enrollment Broker (IEB) at 1-877-550-4227. Paper applications (PA 600 L) are available to download and submit to your local County Assistance Office (CAO), or you can apply in person at a CAO. The application process for waivers has been significantly streamlined, with some cases expedited from 90 days down to around 26 days. A caseworker from the CAO may contact you for additional financial information, and an Independent Enrollment Broker will help determine functional eligibility for CHC.
Last updated: March 2026. Sources: CMS, state Medicaid agency, Genworth 2024.