Pennsylvania Nursing Home Medicaid

Last updated: August 21, 2026 Jurisdiction: Pennsylvania

Nursing-facility care is part of CHC

Eligible Medical Assistance recipients who reside in a Medicaid-paid nursing facility are among the people served through Community HealthChoices. PA Health & Wellness, who CHC serves Financial eligibility, nursing-facility level of care, and the applicable MA process still determine whether coverage is available. PA DHS, Medicaid Payment for Long-Term Care

Unlike the structure described on Florida's nursing-home Medicaid page, Pennsylvania also describes a medically needy spend-down route for certain applicants whose income exceeds the 300%-FBR figure. PA DHS, Medicaid Payment for Long-Term Care

The current personal-needs allowance

PA DHS set the standard long-term-care facility personal-needs allowance at $60 per month effective January 1, 2025, increasing the prior $45 figure. PA DHS MA Bulletin 03-25-33 The DHS operations memorandum lists a $465 allowance for a State Veterans Home resident under enhanced veterans reimbursement. PA DHS Operations Memorandum 24-10-02

Technical note: DHS's current $60 allowance is confirmed in its bulletin and operations memorandum, while the Findlaw-hosted text of 62 P.S. § 443.8 still shows a $45 statutory floor; confirm the current official statutory text for legal drafting. PA DHS MA Bulletin 03-25-33 Findlaw, 62 P.S. § 443.8

How patient pay is calculated

PA DHS's LTC handbook describes patient pay liability as gross monthly income minus the personal-needs allowance, health-insurance premiums, a qualifying community-spouse income allowance, dependent-family-member allowances, and allowable uncovered medical expenses. PA DHS LTC Handbook, Chapter 468.3

The resulting liability is the resident's monthly contribution to the facility, while MA pays the difference between the facility's Medicaid per-diem rate and that liability. PA DHS LTC Handbook, Chapter 468.3

Check spousal and insurance deductions

A community spouse may have resource and income protections under the spousal-impoverishment rules, including the 2026 published CSRA and MMMNA standards. HHS/CMS 2026 Standards See Medicaid (Baseline) for the broader framework and verify each deduction with the current caseworker or qualified adviser.

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Nursing-facility care is part of CHC

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