Q: What is Medicaid?
A: Medicaid is a joint federal-state program that provides health coverage and financial assistance to disabled individuals, senior citizens, and other qualifying individuals. An applicant must meet the financial and medical requirements to be eligible.
Q: What are the eligibility requirements for Medicaid?
A: An applicant must have a medical need for long-term care services, be a US Citizen or a qualified non-citizen, and meet the requirements for financial eligibility by meeting the income and resource guidelines.
Q: Does Medicaid pay for in-home care?
A: In Pennsylvania, Medicaid covers a variety of home care services through different programs and waivers. Medicaid benefits can help cover the cost of in-home nursing services for disabled or older adults with Medicaid waiver programs such as Home and Community Based Services (HCBS) and Living Independence for Elderly (LIFE). These programs provide financial assistance to obtain skilled nursing care while remaining at home.
Q: How much will I have to pay the nursing home each month for my care?
A: Once approved for Medicaid, the amount owed to the nursing home each month for an applicant’s care is based on the applicant’s total gross income. The state will calculate the applicant’s gross income and make any available deductions such as a personal needs allowance, home maintenance deduction, spousal allowance, and Medicare and supplemental health insurance premium deductions. The amount after the available deductions are made is what would be paid to the nursing home each month for the applicant’s care. The applicant’s spouse (also known as community spouse) is NOT required to pay for the applicant’s long-term care services with their own income. The community spouse is allowed to keep all of his/her income, regardless of the amount.
Q: Am I going to lose my home?
A: In the state of Pennsylvania, the primary residence of an applicant can be exempt so long as the home is less than or equal to $730,000 (based on 2025 values), the applicant has the intent to return home, or if the applicant, spouse or dependent child resides in the home.
Q: My loved one is already residing in a nursing home, is it too late to engage in Medicaid planning?
A: It’s never too late to begin Medicaid planning. There are different options and avenues available to preserve your assets from the cost of care at any stage.
Q: What is the 5-year look-back period?
A: Any transfers made within 5 years of applying for Medicaid must be disclosed when applying for Medicaid-funded benefits. If those transfers were made for less than fair market value, a “transfer penalty” may be applied. This penalty is a period of ineligibility for Medicaid long-term benefits. Depending on the amounts and timing of the transfers, it is possible to create a plan to minimize the effects of the penalized period.