Pennsylvania Medicaid Nursing Home Coverage
Pennsylvania Medicaid — Community HealthChoices (CHC) pays for nursing home care for income-eligible Pennsylvania seniors. This guide covers eligibility rules, income and asset limits, the application process, required documents, and important rules families need to understand before applying.
Eligibility at a Glance
Income Limit
$2,742/mo
300% of SSI · Individual
Asset Limit
$2,000
Countable assets · Individual
Look-Back Period
5 Years
Asset transfer review
Spousal Assets Protected
$154,140
Community Spouse Resource Allowance
Spousal Income Protected
$3,854/mo
Min. Monthly Maintenance Allowance
Avg. Nursing Home Cost
$10,500/mo
Medicaid rate: ~$280/day
Pennsylvania Nursing Home Medicaid Income Limit
Pennsylvania nursing home Medicaid income limit: $2,742/month (300% of SSI in 2026). Seniors above this limit may use a Qualified Income Trust (QIT/Miller Trust). Pennsylvania's income limit is the federal standard.
Pennsylvania Nursing Home Medicaid Asset Limit
Pennsylvania asset limit: $2,400 for an individual — slightly above the federal $2,000 standard. Exempt: primary residence (if spouse/dependent lives there or intent to return), one vehicle, burial funds $3,500, household goods, term life insurance. Community spouse asset allowance up to $154,140.
Pennsylvania 5-Year Look-Back Rule
Pennsylvania Medicaid reviews all asset transfers made within 5 years (60 months) of the application date. Transfers for less than fair market value during this period may result in a penalty period during which Medicaid will not pay for nursing home care. Consult a Pennsylvania elder law attorney before transferring any assets.
Important Pennsylvania Nursing Home Medicaid Rules
Community HealthChoices (CHC)
Pennsylvania's long-term care Medicaid is delivered through the Community HealthChoices managed care program. Three CHC-MCOs operate statewide: AmeriHealth Caritas PA, UPMC for You CHC, and Keystone First CHC. All dual-eligible seniors receiving long-term care services are enrolled in a CHC plan. CHC coordinates nursing home care, home-based services, behavioral health, and physical health for enrolled members.
LIFE Program (PA's PACE)
Pennsylvania's LIFE (Living Independence For the Elderly) program is the state's PACE program. LIFE provides comprehensive care for dual-eligible seniors aged 55+ as an alternative to nursing home placement. Pennsylvania has one of the most extensive LIFE/PACE networks in the US. Major LIFE programs: LIFE Pittsburgh, LIFE Geisinger (northeastern PA), LIFE Philadelphia, LIFE Quality Care, and others. Contact PA DHS for programs in your county.
Personal Needs Allowance
Pennsylvania nursing home Medicaid residents keep $45/month as a Personal Needs Allowance — slightly below the national median. All other income is applied to the facility (Patient Pay Amount). Pennsylvania Medicaid pays the approved rate minus the Patient Pay Amount.
Estate Recovery
Pennsylvania participates in Medicaid estate recovery. After a Medicaid nursing home recipient's death (age 55+), the state may file claims against the probate estate. Pennsylvania does NOT pursue recovery against a surviving spouse's estate. Primary residence recovery is pursued only after the surviving spouse's death (if applicable). Pennsylvania elder law attorneys commonly recommend revocable living trusts.
How to Apply for Pennsylvania Nursing Home Medicaid
Pennsylvania Department of Human Services (DHS)
Phone: 800-692-7462 · Website: dhs.pa.gov
- 1Step 1 — Apply through your county Assistance Office (CAO). Find your CAO at dhs.pa.gov. Pittsburgh area: Allegheny County DHS (412-350-4900). Philadelphia: Philadelphia CAO (215-560-7226).
- 2Step 2 — For nursing home admissions, the facility's social worker often guides the application. Most Pennsylvania nursing homes accept Medicaid-pending admissions.
- 3Step 3 — Pennsylvania's Community HealthChoices (CHC) program manages long-term care Medicaid statewide. CHC-MCOs (AmeriHealth Caritas PA, UPMC for You, and Keystone First CHC) coordinate care.
- 4Step 4 — The LIFE program (PACE equivalent) is available as an alternative: LIFE Pittsburgh, LIFE Geisinger, LIFE Philadelphia, and others offer all-inclusive care for dual-eligible seniors.
- 5Step 5 — Medicaid determinations typically take 45–90 days. All approvals backdate to application date.
Documents Required for Pennsylvania Nursing Home Medicaid
Gather these documents before starting your application. Missing documents are the #1 cause of application delays.
- Proof of Pennsylvania residency
- Birth certificate or proof of age
- Social Security card and benefit letter
- Medicare card
- Proof of all income (Social Security, pension, VA, annuity)
- Bank statements for the past 60 months
- Investment account statements
- Property deed (if applicable)
- Vehicle title (if applicable)
- Life insurance policies
- Medical necessity certification from physician or hospital
* Gather 5 full years (60 months) of bank statements for ALL accounts. This is the single most common documentation gap in Medicaid nursing home applications.
Pennsylvania Nursing Home Medicaid by the Numbers
699
Licensed Nursing Homes
75,000
Medicaid Beds
72%
Medicaid Bed %
$10,500
Avg Monthly Cost
Sources: CMS, Pennsylvania Department of Human Services (DHS), 2026 data.
Is There a Waitlist for Pennsylvania Nursing Home Medicaid?
Pennsylvania nursing home Medicaid does not have a formal waitlist. The LIFE program (PACE) and Community HealthChoices home-based services may have limited enrollment capacity in some areas.
Find Medicaid-Accepting Nursing Homes in Pennsylvania
Our care advisors can identify nursing homes in Pennsylvania with open Medicaid beds and help you start the application process — no phone call required.
Pennsylvania Nursing Home Medicaid FAQs
Does Pennsylvania Medicaid cover nursing home care?▾
Yes — Pennsylvania Medicaid (through Community HealthChoices) covers skilled nursing facility care for income and asset-eligible seniors. Income limit: $2,742/month. Asset limit: $2,400. Apply through your county Assistance Office or call PA DHS at 800-692-7462. The facility's social worker typically guides the application for nursing home admissions.
What is Community HealthChoices (CHC) in Pennsylvania?▾
Community HealthChoices is Pennsylvania's managed long-term care program. All dual-eligible (Medicare + Medicaid) seniors receiving long-term care services are enrolled in a CHC managed care plan. The three CHC plans — AmeriHealth Caritas PA, UPMC for You, and Keystone First CHC — cover nursing home care, home-based services, behavioral health, and medical care. CHC has been statewide since 2020.
What is the average cost of nursing home care in Pennsylvania?▾
The average cost of nursing home care in Pennsylvania is approximately $10,500/month ($350/day) for a semi-private room in 2026. Philadelphia area: $11,000–$14,000/month. Pittsburgh area: $9,500–$12,000/month. Rural Pennsylvania: $8,000–$10,000/month. Pennsylvania nursing home costs are above the national average due to high labor and regulatory costs.
What is the LIFE program and is it available where I live?▾
Pennsylvania's LIFE program is the state's PACE (Program of All-Inclusive Care for the Elderly) — providing comprehensive care for dual-eligible seniors aged 55+ at no cost. Pennsylvania has one of the largest LIFE/PACE networks in the US. Programs in: Pittsburgh (LIFE Pittsburgh, UPMC for Life), Philadelphia (LIFE Philadelphia, LIFE Quality Care), Geisinger (northeastern PA), and others. Search for programs at dhs.pa.gov.
Can my parent be admitted to a Pennsylvania nursing home while waiting for Medicaid approval?▾
Yes — most Pennsylvania nursing homes accept Medicaid-pending admissions. The facility agrees to provide care while the Medicaid application is being reviewed. Pennsylvania Medicaid coverage backdates to the application date, so the facility receives payment for the entire admission period once approved. Confirm each facility's Medicaid-pending policy before admission.
Does Pennsylvania recover Medicaid costs from the estate?▾
Yes — Pennsylvania pursues Medicaid estate recovery after the death of a nursing home Medicaid recipient aged 55+. Recovery is limited to the probate estate. Pennsylvania does NOT recover from a surviving spouse's estate. The primary home is generally subject to recovery after all protected persons (surviving spouse, minor/disabled children, or sibling with equity interest) are no longer living there. Revocable living trusts can protect assets from probate and therefore from PA estate recovery.
Related Pennsylvania Medicaid Guides
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