PENNSYLVANIA ANNOUNCES 2025 ELIGIBILITY STANDARDS FOR MEDICAL ASSISTANCE (MEDICAID) FOR LONG-TERM CARE
by: Begley Law Group
by Marianne Johnston, Esq.
With the new year comes changes in several of the Pennsylvania Medicaid eligibility standards for long-term care benefits. What has changed?
- Countable Resource Limit – $2,400 if gross monthly income is greater than $2,901
$8,000 if gross monthly income is $2,901 or less
- Gross Monthly Income limit for Pennsylvania Aging Waiver Program: $2,901
- Maximum Community Spouse Resource Allowance – increased to $157,920
- Minimum Community Spouse Resource Allowance – increased to $31,584.
- Monthly Personal Needs Allowance – increased to $60
- Transfer of Asset Penalty Divisor – increased to $399.80 per day
What do these numbers mean?
Generally, in Pennsylvania, if an applicant’s gross monthly income exceeds the $2,901 income cap, they are not eligible for Medicaid long-term-care benefits in the home and community which includes assisted living facilities. They still can be eligible for benefits in a nursing home.
Do not rely on the monthly deposit amounts shown on bank statements to determine gross monthly income because these amounts are usually net figures after deductions for taxes and Medicare premiums.
When a Medicaid applicant is married, the healthy spouse, known as the Community Spouse, is permitted to keep one-half of the couple’s countable resources subject to the above maximum and minimum limits.
Countable resources do not include the primary residence, one automobile, household items, certain business assets, irrevocable prepaid funerals and burial spaces.
The Monthly Personal Needs Allowances is the amount a Medicaid beneficiary is allowed to keep each month from his/her monthly income while receiving Medicaid benefits.
If a Medicaid applicant transfers assets for less than fair market value during the five-year period preceding the application, eligibility for Medicaid will be delayed. The length of the delay is calculated by dividing the total amount of asset transfers by the penalty divisor, now $399.80. The quotient is the length of the delay in days. For example, if someone transferred assets worth $39,980 during the look-back period, eligibility for benefits would be delayed by 100 days.
Contact Begley Law Group to assist you with Medicaid benefit eligibility and Asset Protection Planning.