Qualifying Factors for Pennsylvania's LTC Medicaid
Do I Qualify for PA Long-Term Care Medicaid (LTC MA)?
In addition to being a US citizen, there are two main eligibility requirements when applying for LTC MA, you must qualify medically and financially.
- Medical: There must be a medical need for LTC MA and a medical evaluation must be completed by your primary physician and submitted to Aging Adult Services for review and approval. If residing in a nursing home, the facility will coordinate the medical evaluation required for LTC MA.
- Financial: There is limited amount of resources (assets) you can own when applying for LTC Medicaid, whether in a nursing facility or in-home care. If applying for in-home care (Aging Waiver), there is also a gross monthly income limit of $2,742 per mo. [2023]. There is no income limit if applying for care in a nursing facility, but LTC MA will only cover the balance remaining after your "income liability" (portion of your income payable to the nursing facility) is applied towards your cost of care. (refer to F.A.Q.s tab above for additional information regarding income liability)
Asset Limit for Applicant
The qualifying asset limit for the applicant is determined by the applicant’s gross monthly income.
Gross Monthly Income of $2,742 or less [2023] = $8,000 max. assets
Gross Monthly Income of $2,743 or more [2023] = $2,400 max. assets
Assets include all bank and investment accounts and applicant’s retirement account/s, as well as all life insurance policy’s cash value, for both the applicant and spouse (if married). Only the primary home (valued under $688k [2023]) and the spouse’s retirement account/s (IRA/401k/Keogh) and one auto are considered “exempt” assets, and are not counted as part of total assets when qualifying for LTC MA.
Asset Limit for Spouse
If married, the spouse’s share of all combined assets (excluding spouse’s IRA, home and auto) is either a minimum of $29,724 or 50% of total assets (not to exceed $148,620) [2023].
- If you are marginally over the asset limit you can use the excess funds to establish an irrevocable burial account for both you and your spouse (County limits apply) and/or pay for medical and nursing facility expense.
- If you are substantially over the asset limit and/or own real estate, you need to know your options.
Caution: Do not gift large amounts of money ($500 or more) or transfer assets without receiving fair market value (FMV), within 5 years prior to needing LTC MA, in an attempt to qualify for LTC MA. Any gifting or transfer of assets for less than fair market value will create a penalty period for the length of time those funds would have covered in a nursing home.
Do You Need Guidance?
It is always in your best interest to know your options and have an advocate on your side, but it’s critical when your assets substantially exceed Medicaid’s qualifying limit. Contact LTC MA Solutions, LLC to schedule a review of your assets and guidance on qualifying for PA Long Term Care Medicaid.
LTC MA Solutions, LLC
