Pennsylvania Medicaid Long Term Care Eligibility
Pennsylvania Long Term Care
People aged 60 and above may qualify for Pennsylvania’s Aging Waiver. This program covers home-delivered meals, home health services, personal assistance, emergency response systems, in-home modifications, and transportation.
For those with a disability, but under age 60, there is the Pennsylvania Attendant Care Waiver. Depending upon the applicant’s income, they may be required to give part of their income towards the cost of their services. If eligible, the Attendant Care Waiver provides personal support, home health services, medical equipment, and an emergency response system to help the recipient stay independent.
Pennsylvania also offers other Home and Community Based Waiver Services (HCBS) described here.
1. Residency and Citizenship – the applicant must be a Pennsylvania resident and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 60 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. Persons must need care for thirty (30) consecutive days.
- In Pennsylvania, before admittance to a nursing home, there is a Pre-Admission Screening and Resident Review (PASRR). PASRR screening determines whether or not an applicant meets the nursing home level of care and also whether a specific facility can meet their needs.
3. Income Limitations – If single, the applicant’s monthly income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than 300% the Federal Benefit Level ($2,313) to become eligible for Medicaid. Income that is not considered countable includes a personal needs allowance of $45.00/month per individual.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt.
Exempt Assets for an applicant in Pennsylvania include:
i. $2,000 or less in cash/non-exempt assets if single. Pennsylvania adds a $6,000 disregard to the asset limit if a Medicaid recipient’s monthly income is below $2,199. If the assets exceed the limit on the first of the month the applicant is ineligible for the entire month.
- For persons who have a monthly income above $2,313, but are medically needy (MNO-MA) with medical expenses that exceed their income, the asset limitation is set at $2,400.
ii. One home is exempt (equity limit $585,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.
iii. One automobile, no equity amount specified.
iv. Irrevocable burial trust, no amount specified.
v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
vi. Value of life insurance if face value has no cash value.
vii. Non-resident property essential to self support (i.e. rental property) if monthly revenue is below income limitations.
Amount of assets community spouse may retain: The community spouse can keep non-exempt resources owned by one or both spouses with a maximum of $126,420. If the community spouse’s assets do not equal the minimum of $25,284, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $2,057.50. The maximum amount of income that can be retained is $3,160.50 varying by case, depending on unique living expenses. If applicable, up to $609.00 in home maintenance and a $570 utility allowance including heat are not figured into the total.
Pennsylvania long term care insurance partnership:
This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used, you may apply for Medicaid with $155,000 worth of assets exempted.
Financial application for Medicaid Long Term Care services: http://www.dhs.pa.gov/cs/groups/webcontent/documents/form/s_002632.pdf
Pennsylvania Medicaid online application site: https://www.compass.state.pa.us/compass.web/CMHOM.aspx
Pennsylvania Department of Human Services general information about Medicaid and payment for Medicaid: http://www.dhs.pa.gov/citizens/longtermcareservices/medicalassistanceandpaymentoflongtermcareservices/