Elder Law & Medicaid Planning Attorneys

This is different work from writing a will. A will decides who receives your assets after death; elder-law planning decides whether those assets survive the cost of care in the first place. Many families learn the difference the hard way, after a parent enters a facility and a lifetime of savings begins to disappear. With planning — ideally early, but even in a crisis — far more can be protected than most people realize.

Long-term care and Medicaid in Pennsylvania

Medicare does not pay for long-term custodial care — only about 100 days of short-term rehabilitation. Extended nursing-home care is paid privately, through long-term-care insurance, or through Medicaid (Medical Assistance). Medicaid is means-tested: a single applicant must spend countable assets down to a strict limit — only a few thousand dollars (the 2026 limits run from $2,400 to $8,000 depending on income, and are adjusted yearly). But several things are exempt — your home (within an equity limit), one vehicle, personal belongings, and a prepaid irrevocable burial — and the specific dollar limits change every year, so they should always be checked against the current figures. The goal of planning is to convert and protect assets legally, not to "hide" them.

The five-year look-back — the most expensive mistake

The single most common and costly error is giving assets away to qualify — for example, deeding the house to the kids. Medicaid reviews five years (60 months) of financial records, and any gift or below-value transfer in that window creates a penalty period of ineligibility, calculated from the amount transferred. Worse, the penalty does not start when you make the gift — it starts later, once you are already in a facility and out of money. Giving the house away also forfeits a valuable capital-gains tax benefit (the "step-up in basis"). There are lawful ways to transfer assets, but they have to be structured correctly and at the right time.

Will Medicaid take my home?

Not while you or your spouse is living. After death, Pennsylvania runs an Estate Recovery program to recoup what it paid — but PA only recovers against the probate estate. Assets that pass outside probate — jointly owned property with survivorship, a properly structured irrevocable trust, or accounts with a named beneficiary — generally fall outside the state's reach. Because the home is exempt during life but passes through probate at death, it is the most common target, which is exactly why how the home is titled and planned matters so much.

It is not too late once a parent is already in care

A five-year-old irrevocable trust is the cleanest protection, but it is far from the only tool. Even after admission, crisis-planning strategies — Medicaid-compliant annuities, "half-a-loaf" gifting paired with an annuity, and statutory exemptions such as the caregiver-child transfer — can preserve a substantial portion of an estate. The worst outcome is doing nothing, or doing it yourself and triggering a penalty no one saw coming.

A Pennsylvania risk many families miss: filial support

Pennsylvania is one of the few states that actively enforces a filial-support law (23 Pa.C.S. § 4603): adult children can be held personally liable for an indigent parent's unpaid care. In Health Care & Retirement Corp. of America v. Pittas, a son was held responsible for his mother's $93,000 nursing-home bill — and liability is "joint and several," meaning a facility can pursue the child with the most resources. A botched do-it-yourself transfer that leaves a facility unpaid can land squarely on the children. Proper planning protects the whole family, not just the parent.

Why your power of attorney decides everything

If a parent loses capacity before planning is done, the family's ability to act depends entirely on the financial power of attorney. Under Pennsylvania law (20 Pa.C.S. § 5601.4), an agent can only make gifts, create or fund trusts, or change beneficiary designations if the POA expressly grants those "hot powers." A generic, downloaded POA leaves your agent powerless to protect anything — and forces the family into an expensive, public guardianship case instead. Getting this one document right, in advance, is the difference between options and a courtroom.

How we help

For decades, the attorneys of Cramer, Swetz, McManus, Jordan & Saylor have helped Northeastern Pennsylvania families navigate aging, incapacity, and the cost of care — from proactive asset-protection plans to crisis Medicaid planning when a loved one is already in a facility. We coordinate the documents (POAs and directives with the right powers), the strategy (trusts, annuities, exemptions), and the benefits (Medicaid and VA), and we know the Monroe County agencies and Orphans' Court. We will tell you honestly what can and cannot be protected in your situation.

Frequently asked questions