What an Elder-Law Attorney Does for Medicaid Eligibility in Pennsylvania: The Review, the Look-Back, the Application and Estate Recovery

Elder Law & Medicaid Planning — Monroe County, PA

What does an elder law attorney do for Medicaid eligibility in Pennsylvania? The work has five parts: measuring income and assets against Medical Assistance’s long-term-care limits, reviewing five years of transfers, applying the spousal protections, preparing and documenting the application, and planning for estate recovery. Much of it can still be done after a nursing-home admission.

Pennsylvania calls the program Medical Assistance (MA). Figures below are from Department of Human Services (DHS) pages read October 18, 2026; many change yearly.

The Eligibility Review: Income and Assets Against the Current Limits

The first job is measuring income and countable resources against DHS’s long-term-care limits.

Source: DHS Long-Term Care Handbook, Chapter 468 and Chapter 440 Appendix A.

With income above $2,982, DHS treats the anticipated cost of six months of nursing-facility care as a medical expense that reduces countable income (DHS). Countable resources include bank accounts, stocks, bonds and mutual funds, IRA and Keogh accounts, and non-resident property. The home does not count if the applicant lives there or intends to return and its equity is $752,000 or less, or if a spouse or dependent lives there; one motor vehicle, burial spaces and burial reserves within set limits do not count either.

The 60-Month Look-Back and the Transfer Penalty

The attorney reviews every gift or below-value transfer in the 60-month look-back period (for a new applicant, the five years before the application; for someone already on MA, before the admission or home-care assessment), because each can create a penalty period. The penalty equals the uncompensated value divided by DHS’s average daily private-pay rate, $421.20 effective January 1, 2026, and it begins when the applicant would otherwise be eligible, not when the gift was made.

Under the handbook’s transfer rules, the rate is the one in effect when the penalty is set, and transfers totaling $500 or less in a month are not counted.

Some transfers of the home carry no penalty, including a transfer to a spouse, to a child under 21 or a blind or disabled child, to a sibling with an equity interest who lived there for at least a year immediately before the parent entered care, or to a son or daughter who lived in the home for at least two years immediately before the parent entered care and provided care that kept the parent at home. That caregiver exception requires records of the child’s residency and a doctor’s written statement about the care (Handbook § 440.8). See our guide to protecting a home and savings from nursing-home costs.

Spousal Protections When One Spouse Needs Care

When one spouse needs care, the at-home (“community”) spouse generally keeps one-half of the couple’s countable resources, but no less than $32,532 and no more than $162,660, figures effective January 1, 2026; a fair hearing can increase that share.

The couple’s resources are measured as of the first day of a continuous stay of at least 30 days (Handbook § 440.9), on a Resource Assessment Form (PA 1572). The community spouse keeps his or her own earnings and may receive an allowance from the other’s income: the minimum monthly maintenance needs allowance is $2,705 (effective July 1, 2026), the maximum is $4,066.50 (effective January 1, 2026), and the excess shelter standard is $812 (effective July 1, 2026). Pennsylvania uses the institutionalized spouse’s income first; only if a shortfall remains can additional resources be protected to produce income, a request made through a fair hearing.

Preparing and Documenting the Application

The application goes to the County Assistance Office (CAO), online through COMPASS, on paper, or by phone at 1-866-550-4355, which DHS’s Consumer Service Center began offering for long-term care on June 16, 2025 (DHS).

DHS’s application guide (PA 1996, July 2025) lists monthly statements for the most recent two years of the look-back period and semi-annual statements for the other three, among other items; the CAO’s pending verification list is the official request. The CAO decides within 30 days and may extend that by 15 days with a letter explaining the delay and the right to request a fair hearing; unusual circumstances can push past 45 days, and an applicant awaiting a bed or slot can be held pending up to 120 days (Handbook § 404.5). MA can currently cover up to three months before the application month (a window DHS says shrinks on January 1, 2027), but a late or incomplete application can still leave a private balance with the facility; see whether a nursing home can come after your children for the bill.

Estate Recovery: Planning for What Comes After

Pennsylvania recovers what MA paid for nursing-facility care, home- and community-based services, and related hospital and prescription drug services from the probate estate of a recipient who was 55 or older when the assistance was received (62 P.S. § 1412). The claim reaches property subject to administration by the personal representative; property held with a right of survivorship, entireties property and life insurance payable directly to a beneficiary are not subject to it (55 Pa. Code § 258.3).

The personal representative of a decedent who was 55 or older must check whether MA was paid in the five years before death and, if so, notify DHS, which must submit its claim within 45 days of that notice or forfeit it. Collection is postponed while a surviving spouse is living, until a surviving child turns 21, while a blind or disabled child is living, and until a sibling with an equity interest who lived in the home for at least a year before the death dies, transfers the property or moves out (§ 258.7), and DHS can waive its claim for undue hardship (§ 258.10). See our probate and estate administration page.

Is It Too Late After a Nursing-Home Admission?

Often it is not. The spousal protections, the home-transfer exceptions, legitimate spending, a complete and well-timed application and, in some cases, an annuity that meets every DHS condition (including naming DHS as remainder beneficiary in the required position, Handbook § 440.881) all remain available after admission.

If a parent no longer has capacity, an agent can make gifts or change beneficiaries only if the power of attorney expressly grants that authority, and then only within the statute’s limits (20 Pa.C.S. § 5601.4). Without one, a guardian needs court approval, which requires showing the assets are not needed for the person’s support and the plan minimizes taxes or continues a lifetime giving pattern (§ 5536(b)). In In re S.C., 2026 PA Super 140 (July 1, 2026), the Superior Court affirmed the partial denial of a guardian’s Medicaid spend-down and gifting plan that lacked that evidence.

Frequently Asked Questions

What are Pennsylvania’s Medicaid resource limits for nursing-home care in 2026?

For one person, $2,000 plus a $6,000 disregard if monthly income is at or below $2,982 (effective January 1, 2026), and $2,400 if income is above it.

How long is the Medicaid look-back in Pennsylvania?

Sixty months. A below-value transfer in that period can create a penalty equal to the uncompensated value divided by $421.20 a day (effective January 1, 2026), beginning when the applicant would otherwise be eligible.

Facing a Nursing-Home Admission in the Poconos? Speak With CSMJ

At CSMJ Law, we help Monroe County families with Medicaid planning, from planning ahead to crisis planning when a loved one is already in a facility. See our elder law and Medicaid planning and estate planning and administration pages.

To schedule a confidential consultation, call (570) 421-5568 or contact us online. Our office is at 711 Sarah Street, Stroudsburg, PA 18360.

This article is general legal information, not legal advice, and does not create an attorney-client relationship. Medicaid figures change often, and eligibility depends on your specific facts. Consult a licensed Pennsylvania attorney about your situation.

CSMJ Law Firm