Pennsylvania Medicaid & Elder Care
Pennsylvania's Community HealthChoices program streamlines long-term care for seniors, offering home and community-based services through managed care with strict income and asset limits.
Medicaid Report Card
Overall State Performance Index
Based on CMS Nursing Home Compare + state Medicaid agency data
View Methodology arrow_forwardPennsylvania Monthly Costs
Pennsylvania's median assisted living costs, at approximately $6,100 per month in 2026, trend slightly above the national average of $5,900.
Waiver Programs
Community HealthChoices (CHC) Waiver
Also called: Aging Waiver (replaced), Attendant Care Waiver (replaced), Independence Waiver (replaced)
Community HealthChoices is Pennsylvania's mandatory Medicaid managed care program for seniors and adults with physical disabilities requiring long-term services and supports. It provides home and community-based services to help eligible individuals remain in their homes or community settings instead of nursing facilities.
- check_circle Personal Care
- check_circle Adult Day Health
- check_circle Home Delivered Meals
- check_circle Assistive Technology
- check_circle Home Modifications
- check_circle Skilled Nursing Supervision
- check_circle Service Coordination
- check_circle Behavior Therapy
- check_circle Benefits Counseling
insights Program Snapshot
- Functional criterion
- Nursing Facility Level of Care (NFLOC) / Nursing Facility Clinically Eligible (NFCE)
- Administered by
- PA Department of Human Services, Office of Long-Term Living (OLTL)
- Managed Care Organizations
- AmeriHealth Caritas, PA Health & Wellness, UPMC Community HealthChoices
- Enrollment
- Mandatory for eligible individuals 21+ who are dual-eligible or need LTSS
2026 Eligibility Requirements
| Criteria | Individual Limit | Married (Both Applying) |
|---|---|---|
| Monthly Income | $2,982 | $5,964 |
| Asset Limit | $2,000 | $3,200 |
| Home Equity Limit | $752,000 | |
| Level of Care | Nursing Home Level of Care (NHLOC) | |
Estate Recovery Warning
Pennsylvania's Medicaid Estate Recovery Program is aggressive, seeking reimbursement for long-term care costs from the estates of deceased beneficiaries, including placing liens on homes, though certain protections exist for surviving family members.
Spend-Down & Asset Protection
PROTECTED ASSETS
COMMON PITFALLS
- warning Look-back Period: Gifts or transfers for less than fair market value within 60 months prior to application trigger penalties.
- warning Excess Income: Failing to establish a Miller Trust (Qualified Income Trust) if monthly income exceeds the waiver cap.
- warning Joint Accounts: The full balance of jointly owned bank accounts is often counted as the applicant's asset, regardless of contribution.
First Steps for Families
Locate your ADRC
Contact your local Pennsylvania Aging and Disability Resource Center.
Gather 5 years of records
Bank statements, deeds, asset transfers for the Medicaid look-back period.
Financial assessment
Consult a Medicaid planner if assets exceed $2,000.
Resource Contact
Pennsylvania Department of Human Services
How to Apply for Pennsylvania Long-Term Care Medicaid
Contact Independent Enrollment Broker
Call the Independent Enrollment Broker (IEB) at 1-877-550-4227 to start the application for long-term services and supports.
Undergo Functional Assessment
A face-to-face assessment will be scheduled by the IEB to determine if the Nursing Facility Level of Care is met.
Gather Financial Records
Collect 60 months of financial statements, income verification, and asset documentation for review by the County Assistance Office.
Establish Miller Trust (if needed)
If monthly income exceeds the waiver limit, a Qualified Income Trust (Miller Trust) must be established to deposit excess income.
Submit Application
Apply online via COMPASS (compass.state.pa.us), in-person at a County Assistance Office, by phone, or via mail.
Caseworker Review and Determination
A caseworker will review the application and supporting documents, potentially requesting additional information or an interview, and issue an eligibility determination.
Documents You'll Need
Financial Verification
- 60 months of bank statements
- Stock/bond certificates
- Retirement account information
- Life insurance policies
Income Verification
- Social Security award letters
- Pension statements
- VA benefit statements
- Pay stubs
Medical/Identity
- Social Security card
- Medicare card
- Government-issued photo ID
- Birth certificate
- Doctor's clinical assessments (MA 51)
- Functional Eligibility Determination (FED)
Property/Residency
- Home deed
- Vehicle registration
- Proof of Pennsylvania residency (e.g., utility bills, lease agreement)
Frequently Asked Questions About Pennsylvania Medicaid
Does Pennsylvania Medicaid pay for assisted living?
Pennsylvania's Community HealthChoices (CHC) program may cover some long-term care services and supports in assisted living residences for eligible seniors. However, the program does not cover the cost of room and board in these facilities. Individuals must meet Nursing Facility Level of Care criteria and financial eligibility requirements to qualify for CHC services.
What is the Pennsylvania Medicaid income limit for seniors in 2026?
For long-term care Medicaid and Home and Community-Based Services (HCBS) waivers in Pennsylvania, the individual monthly income limit for seniors in 2026 is $2,982. For married couples where both are applying, the limit is $5,964. If income exceeds this cap for waivers, a Miller Trust is generally required.
How long is the HCBS waiver waitlist in Pennsylvania?
Pennsylvania's primary Home and Community-Based Services (HCBS) program for seniors, Community HealthChoices (CHC), operates as a mandatory managed care program for eligible individuals. Once functional and financial eligibility are met, there is no waitlist for services. The application and enrollment process typically takes between 30 and 90 days.
Will Medicaid take my parent's house in Pennsylvania?
Pennsylvania Medicaid generally protects a primary residence during the applicant's lifetime if a spouse or a permanently disabled/minor child lives there, or if the home equity is below $752,000. However, the home is not exempt from the state's Estate Recovery Program after the beneficiary's death, which may seek reimbursement for care costs.
Can I be paid to care for my parent through Pennsylvania Medicaid?
Yes, Pennsylvania's Community HealthChoices (CHC) program allows eligible family members to be paid caregivers for their loved ones through Participant-Directed Services or an Agency with Choice model. The parent must meet a nursing-facility level of care and be enrolled in CHC. Spouses are generally not eligible to be paid caregivers.
Medicaid vs Medicare for long-term care in Pennsylvania?
Medicare in Pennsylvania primarily covers short-term, skilled nursing facility stays for rehabilitation, but it does not cover long-term custodial care. Medicaid (Medical Assistance) is a needs-based program that covers extensive long-term care services, including nursing home care and home and community-based services through programs like Community HealthChoices, for eligible seniors.
TOPICAL GUIDES — HOW MEDICAID WORKS
EXPLORE PENNSYLVANIA
Last updated: April 24, 2026. Sources: Pennsylvania Department of Human Services, CMS Nursing Home Compare, Genworth 2024 Cost of Care Survey. Eligibility rules are set by each state Medicaid agency and update annually. We cite the agency name, statute, or CMS data source for every figure on this page; see our methodology and editor.