Pennsylvania Medicaid for Seniors & Long-Term Care

Community HealthChoices launched in January 2018 in Southwest Pennsylvania, with Phase 2 following in January 2019 in Southeast Pennsylvania. Phase 3 — the final statewide expansion — went live in January 2020, completing the transition for all remaining counties. Pennsylvania moved the state's entire dual-eligible population into CHC over three years, replacing waivers that had operated for decades.

The five CHC managed care organizations are Aetna Better Health of Pennsylvania, Health Partners Plans, PA Health and Wellness, UPMC For You, and AmeriHealth Caritas/Keystone First (Vista Health Plan). Enrollment into CHC is handled through an Independent Enrollment Broker (IEB) — a neutral third party under contract with DHS. Contact the IEB at 1-877-398-5346 to enroll, switch plans, or get help understanding your CHC options.

CHC's stated goal is to serve more Pennsylvanians in community settings rather than nursing facilities. Research published in JAMA Health Forum (2023, Roberts et al.) found that CHC enrollment in Pennsylvania was associated with an increase of 0.61 HCBS days per month per enrollee compared to those remaining in traditional Medicare — confirming CHC's shift toward community-based care.

Medicaid pays for nursing facility care in Pennsylvania when a person meets both financial and clinical eligibility requirements. Financial eligibility follows non-MAGI rules: for 2026, the individual monthly income limit is $2,982 (300% of the federal benefit rate), and if income is at or below that limit, the resource limit is $2,000 plus an additional $6,000 resource disregard — $8,000 in total, per DHS guidance. Applicants whose income exceeds $2,982/month instead have a $2,400 resource limit.

Income rules for nursing facility residents follow the post-eligibility rules: the resident contributes most of their income toward their care (the "patient pay amount"), retaining a personal needs allowance of $60 per month (increased from $45, effective January 1, 2025, per DHS). If the resident has a community spouse, the income rules are more generous — the community spouse may retain a Minimum Monthly Maintenance Needs Allowance (MMMNA).

Pennsylvania enforces a 60-month (five-year) asset transfer look-back period. Assets transferred below fair market value within 60 months of a nursing facility application trigger a period of ineligibility. Transfers to a community spouse or a disabled child are exempt.

Pennsylvania's Living Independence for the Elderly (LIFE) program is a PACE-like (Program of All-inclusive Care for the Elderly) model for individuals 55 and older who need nursing facility level of care but want to remain in the community. LIFE providers offer adult day health services, primary care, therapy, and transportation at a LIFE center. Enrollment is voluntary for CHC-eligible individuals, and LIFE providers operate in selected areas of the state — check with DHS or call 1-800-692-7462 to see whether a LIFE program serves your county.

To request CHC or HCBS enrollment more broadly, apply through COMPASS or call DHS at 1-800-692-7462. You can also request a referral directly through the COMPASS website for home- and community-based services that are not applied for through the standard COMPASS application.

Federal law protects the assets and income of the community spouse (the spouse not in a nursing facility) from being fully depleted to pay for the institutionalized spouse's care. Pennsylvania's $8,000 individual asset limit is notably lower than some states, such as New York ($31,175) or Texas ($2,000), which makes understanding these protections especially important for Pennsylvania families.

Pennsylvania operates a Medicaid Estate Recovery Program (MERP) as required by federal law. After a Medical Assistance recipient who received nursing facility services, HCBS waiver services, or related services dies, DHS may file a claim against the recipient's estate to recover the cost of those services. Recovery applies to individuals who were 55 or older when they received services, and to any age for nursing facility care.

Unlike some states, Pennsylvania limits estate recovery to probate assets — the program does not pursue jointly held property that passes outside of probate (such as jointly held real estate with a right of survivorship) in most circumstances. Recovery is deferred while a community spouse, a minor child, or a blind or disabled child is living, and hardship waivers are available if recovery would cause undue hardship to surviving household members. Consult an elder law attorney before transferring property if a family member is enrolled in long-term care Medicaid.