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What are Medicaid’s income eligibility limit for long-term care in PA?

On Behalf of | Mar 31, 2021 | Medicaid and Medical Assistance | 0 comments

If your elderly parent is like most people who need nursing home care, he or she is either “over-income,” “over-asset” or both. Yet, your family may still struggle to afford the high cost of long-term care. Your family is not alone.

Medicaid’s income and asset eligibility requirements are strict. The income limit for an applicant for at-home care in 2021 in Pennsylvania is $2,382 per month.  For nursing home care, the applicant’s income must be less than the average monthly cost of nursing home care, which is presently $364.90 per day or approximately $11,099.04 per month. There are also asset limits, which are discussed in other blogs on our website.  The American Council on Aging explores two routes you can take to help your loved one qualify for Medicaid.

The Medically Needy Pathway

Pennsylvania has a program called the “Medically Needy Pathway,” which the state designed to help individuals who are over the income limit but who have excessively high medical bills. This program is not usually used for paying for long-term care. Otherwise called the “Spend-down” program or the “Medically Needy Only Medical Assistance” program, the way it works is that it allows individuals to use their “surplus income” to cover the cost of necessary medical bills. “Medical bills” can, for Medicaid purposes, include short-term nursing home costs. As of early 2021, the excess income limit for medically needy individuals is $425. Your parent has six months to “spend down” his or her extra income to meet Medicaid’s eligibility limit and qualify for the rest of the six-month period.

Unfortunately, you cannot use this pathway to spend down assets for long-term care. If your loved one is over the asset limit, you must explore other ways to spend down assets, such as using them to pre-pay for funerals, buy cemetery plots, pay off a mortgage, etc.

Medicaid planning

For most families, the only way to qualify for Medicaid long-term care involves comprehensive and early planning. There are dozens of strategies your family can employ to help your loved one qualify for Medicaid in the future and protect his or her home or estate from long-term care costs.  Again, some of these strategies are on other blogs on our website.