Medicaid can cover assisted living in Pennsylvania for people who need help with daily activities, such as bathing, dressing, eating and taking medication. To qualify, individuals must meet certain financial requirements and must be 65 or older, blind or disabled. Medicaid can pay for assisted living in three ways: personal care homes, waiver programs or nursing homes. For personal care homes, Medicaid must determine a person needs this level of care. Waivers vary in eligibility and requirements, but people can live in various care settings, including assisted living facilities. Lastly, nursing homes are covered when people need skilled nursing care.
Eligibility Requirements for Medicaid-Funded Assisted Living in Pennsylvania
To be eligible for Medicaid-funded assisted living in Pennsylvania, individuals must meet specific income, asset, and functional need requirements. It’s important to note that eligibility criteria may change over time, so it’s essential to check with the Pennsylvania Department of Human Services for the most up-to-date information.
Income and Asset Limits
- Income Limit: For 2023, the income limit for an individual to qualify for Medicaid-funded assisted living is $2,493 per month. For a married couple, the income limit is $4,987 per month.
- Asset Limit: The asset limit for an individual to qualify for Medicaid-funded assisted living is $2,000. For a married couple, the asset limit is $3,000.
Functional Need Requirements
- Individuals must require assistance with activities of daily living (ADLs), such as bathing, dressing, eating, and toileting.
- They must also be at risk of nursing home placement without the assistance provided in an assisted living setting.
Additional Considerations
In addition to meeting the income, asset, and functional need requirements, individuals must also be:
- A Pennsylvania resident.
- Age 65 or older, blind, or disabled.
- A U.S. citizen or a qualified non-citizen.
It’s worth noting that the Pennsylvania Department of Human Services may consider additional factors when determining eligibility, such as an individual’s living situation, medical needs, and support network.
| Requirement | Details |
|---|---|
| Income Limit | $2,493 per month for individuals, $4,987 per month for married couples (2023) |
| Asset Limit | $2,000 for individuals, $3,000 for married couples |
| Functional Need Requirements | Require assistance with ADLs and at risk of nursing home placement without assisted living |
| Additional Considerations | Must be a PA resident, age 65+, blind, or disabled, and a U.S. citizen or qualified non-citizen |
If you believe you may be eligible for Medicaid-funded assisted living in Pennsylvania, you can apply through your local County Assistance Office or online through the COMPASS website. The application process may involve providing documentation to verify your income, assets, and functional needs.
Medicaid Coverage for Assisted Living in Pennsylvania
While Medicaid does not cover assisted living directly, it may provide funding for certain services received in an assisted living facility. These services must be medically necessary and meet specific criteria set by the state.
Services Covered by Medicaid-Funded Assisted Living in Pennsylvania
- Personal Care Services: This includes assistance with activities of daily living (ADLs) such as bathing, dressing, grooming, and eating.
- Skilled Nursing Care: This includes services provided by a licensed nurse, such as wound care, injections, and medication management.
- Occupational Therapy: This helps individuals regain or maintain skills needed for daily living, such as dressing and eating.
- Physical Therapy: This helps individuals improve their mobility and strength.
- Speech Therapy: This helps individuals improve their communication skills.
- Social Work Services: This includes counseling and support for individuals and their families.
To be eligible for Medicaid-funded assisted living in Pennsylvania, individuals must meet certain requirements, including:
- Being a resident of Pennsylvania.
- Being 65 years of age or older, blind, or disabled.
- Having a low income and limited assets.
- Requiring assistance with ADLs.
| Service | Covered by Medicaid |
|---|---|
| Personal Care Services | Yes |
| Skilled Nursing Care | Yes |
| Occupational Therapy | Yes |
| Physical Therapy | Yes |
| Speech Therapy | Yes |
| Social Work Services | Yes |
It’s important to note that Medicaid coverage for assisted living services may vary depending on the individual’s needs and the specific assisted living facility. It is recommended to contact the local Medicaid office or a qualified professional for more information and guidance.
Medicaid-Funded Assisted Living in Pennsylvania
Medicaid, a state and federal health insurance program, provides comprehensive medical coverage to low-income individuals and families. In some states, including Pennsylvania, Medicaid can also cover the cost of assisted living services for people who meet specific eligibility criteria. This article explains how to apply for Medicaid-funded assisted living in Pennsylvania.
Eligibility
To be eligible for Medicaid-funded assisted living in Pennsylvania, you must meet the following criteria:
- Be age 65 or older, or have a disability
- Have a low income and assets
- Require assistance with activities of daily living (ADLs), such as bathing, dressing, or eating
- Be in need of a nursing home level of care, but prefer to live in an assisted living facility
The income and asset limits for Medicaid eligibility vary depending on your marital status and living situation. For more information, visit the Pennsylvania Department of Human Services (DHS) website.
Applying for Medicaid-Funded Assisted Living
To apply for Medicaid-funded assisted living in Pennsylvania, you can:
- Contact your local DHS office or call the DHS customer service line at 1-800-692-7462.
- Request an application for Medicaid long-term care benefits.
- Complete the application and submit it to your local DHS office.
You will need to provide documentation to support your application, such as proof of income, assets, and medical conditions. The DHS will review your application and determine if you are eligible for Medicaid-funded assisted living.
Covered Services
Medicaid-funded assisted living in Pennsylvania covers a wide range of services, including:
- Personal care services, such as bathing, dressing, and grooming
- Assistance with activities of daily living (ADLs), such as eating, toileting, and transferring
- Skilled nursing care
- Occupational therapy
- Physical therapy
- Speech therapy
- Social services
- Nutritional counseling
- Medication management
The specific services that you receive will depend on your individual needs.
Cost
The cost of Medicaid-funded assisted living in Pennsylvania varies depending on the facility you choose and the level of care you need. However, Medicaid will pay for the cost of your care, up to a certain limit. You may be responsible for paying a monthly co-payment for your care.
| Income Level | Co-Payment Amount |
|---|---|
| Less than $2,000 per month | $0 |
| $2,000 to $3,000 per month | $50 |
| More than $3,000 per month | $100 |
Choosing a Facility
There are many assisted living facilities in Pennsylvania that accept Medicaid. When choosing a facility, you should consider the following factors:
- The location of the facility
- The size of the facility
- The type of care provided
- The cost of care
- The reputation of the facility
You can visit assisted living facilities in person or tour them virtually. You should also talk to the staff at the facility to learn more about the care they provide.
Once you have chosen a facility, you can submit an application for admission. The facility will review your application and determine if you are eligible for admission.
Pennsylvania Medicaid’s Role in Assisted Living
In Pennsylvania, Medicaid coverage for assisted living is available to those who qualify for Medicaid benefits. Medicaid is a joint federal and state program that provides health coverage to low-income individuals, families, and children, people with disabilities, and seniors.
Medicaid-Funded Assisted Living in Pennsylvania
- Who is Eligible? To be eligible for Medicaid-funded assisted living in Pennsylvania, an individual must meet certain requirements, including:
- Being 65 years or older, or having a disability
- Having a qualifying income and assets
- Requiring assistance with activities of daily living (ADLs), such as bathing, dressing, or eating.
Benefits Covered services under Medicaid-funded assisted living may include:
- Personal care services (bathing, dressing, toileting, eating)
- Medication management
- Meal preparation and assistance
- Laundry services
- Social and recreational activities
- Transportation to medical appointments
Costs The cost of assisted living is typically covered by a combination of Medicaid and the individual’s income and assets.
How to Apply To apply for Medicaid-funded assisted living in Pennsylvania, individuals can contact their local county assistance office.
Additional Resources
- Pennsylvania Department of Human Services: https://www.dhs.pa.gov/Services/Pages/Long-Term-Living.aspx
- Medicaid.gov: https://www.medicaid.gov/medicaid/long-term-services-supports/home-community-based-services/index.html
| Income Level | Asset Limit | Monthly Medicaid Contribution |
|---|---|---|
| Up to $2,382 | Up to $2,000 | $0 |
| $2,383 – $3,573 | $2,001 – $4,000 | Up to $1,188 |
| $3,574 – $4,764 | $4,001 – $6,000 | Up to $1,782 |
| Over $4,764 | Over $6,000 | Full cost of care |