FAQs

The Medicaid lookback period is the first thing most Pennsylvania families ask about. These Medicaid planning FAQs explain the lookback period and answer the other questions families ask most, from how the Medicaid penalty calculation works to “will Medicaid take my house?” and how asset limits protect a spouse. For the federal overview, see the Medicaid long-term services and supports page.

Couple reviewing paperwork with an asset protection Medicaid planner in Pennsylvania

Getting Started With Medicaid Planning in Pennsylvania

Why should I hire Fieldstone Medicaid Planning? Can't I just do this on my own?

The Application Process
You can fill out the Medicaid application yourself, though there’s a lot to consider. Gathering and accurately presenting five years of financial information is crucial to avoid penalties or denials. Losing Medicaid coverage for a nursing home costing over $12,000 a month can be devastating.

Determining Eligibility
We’ll determine your Medicaid eligibility and discuss spenddown alternatives if you exceed the asset limit. Many mistakenly believe they aren’t eligible until they’ve depleted their life savings. A Medicaid planner helps you avoid costly missteps. Our Medicaid planning guide for aging parents explains the steps in more depth.

Ideally, well before care is needed. Planning five or more years in advance offers the most options because Medicaid does not penalize transfers made outside the lookback period. But planning is valuable at any stage: before a move to a nursing home, during a private-pay period, or when an application has been delayed or denied. See our Medicaid eligibility in Pennsylvania review and Pennsylvania nursing home Medicaid page for details.

No. Many families contact us after a parent has already entered a nursing home and is paying privately. Even at that stage, there are often legal ways to protect a meaningful portion of assets and to make sure Medicaid eligibility begins as early as possible.

Every month of private payment spent unnecessarily is money you can never get back, so it’s worth having a conversation sooner rather than later.

Fieldstone Medicaid Planning is not a law firm, and we don’t provide legal advice. Our Certified Medicaid Planner™ focuses on eligibility analysis, planning strategy and the Medicaid application process.

When a situation calls for legal documents, such as trusts, powers of attorney or wills, we work alongside the family’s attorney or can suggest that you consult one.

Your first consultation is free and comes with no obligation. After reviewing your situation, we explain which services you need and what they will cost before any work begins. See our Medicaid application help page for more details.

Our office is at 2003 S Easton Road in Doylestown, where we meet clients by appointment. We help families throughout Pennsylvania, including Bucks, Montgomery and Philadelphia counties, by phone, video and in person.

Medicaid Eligibility, Assets and the Lookback Period in Pennsylvania

Why do I need Medicaid? Won't Medicare pay for my nursing home?

Medicare and Medicaid are different programs. 

What does Medicare cover?

Medicare covers short-term skilled nursing or rehab care after a qualifying hospital stay of at least three days as an inpatient.  It fully covers the first 20 days, then requires a co-payment for days 21 to 100. Medicare does not pay for long-term custodial care, which is help with bathing, dressing, eating and supervision.  That is the care most nursing home residents need.

Coverage ends when a person no longer needs daily skilled care, or after 100 days, whichever comes first. In addition, Medicare coverage ends when a person reaches their normal baseline, not a higher level of fitness.  If a person relied on a walker before breaking their hip, Medicare will not pay for additional therapy to help them walk completely unassisted.

Unlike  means-tested programs, anyone can qualify for Medicare regardless of income.

What does Medicaid cover?

In Pennsylvania, Medical Assistance (Medicaid) is the main way families pay for long-term nursing care once private funds run low.  It also funds certain in-home and community care through the Community HealthChoices program.   

To qualify for Medicaid, a person’s assets and income must be below certain thresholds.  Pennsylvania may later seek repayment from the recipient’s estate, which we call estate recovery.  See “Will Pennsylvania take money from my parent’s estate?” below.

For 2026, a single nursing home applicant in Pennsylvania can generally keep $2,400 in countable assets, or up to $8,000 if their gross monthly income is $2,982 or less. Certain assets don’t count toward that limit, including the home (within equity limits), one vehicle, personal belongings and a properly arranged burial fund.

If you’re over the limit, spending down doesn’t mean losing everything. See our Medicaid spend-down guide for what counts, what’s exempt, and legal ways to reduce excess assets.

Assets generally not counted include the primary residence (within equity limits), one vehicle, household goods and personal effects, burial plots, and an irrevocable funeral or burial arrangement. Medicaid typically counts retirement accounts, bank accounts, CDs, investments, life insurance with cash value and second properties.

The way you title and structure an asset matters, so the details deserve a careful review before any money is moved.

Medicaid Lookback Period

The Medicaid lookback period in Pennsylvania covers five years (60 months) of financial records before a Medicaid application. Gifting assets, selling below market value, or buying above market value during that window can trigger a penalty period before benefits start.

Learn how the look-back works, what counts as a gift, and how penalties are calculated in our Medicaid look-back guide.

Medicaid runs any gift in that window through the penalty calculation described below, which is why planning before you apply matters.

Medicaid Penalty
Medicaid imposes a penalty if an applicant gifts assets during the lookback period to gain eligibility. The penalty delays eligibility and isn’t a monetary fine. Pennsylvania divides the total amount of transfer by the state’s penalty divisor, which is $421.20 per day (or $12,811.50 per month), for 2026.

Medicaid Penalty Calculation Example
For example, if  a Medicaid applicant gave $50,000 to a child within the lookback period, the penalty would be about 3.9 months.  During those months, Medicaid will not pay for care, even though the applicant otherwise qualifies.  The penalty doesn’t start until the applicant has submitted the application and is otherwise eligible, which is why unplanned gifts can be so costly.

Because the Medicaid penalty calculation counts every transfer made during the lookback period, even small gifts add up. Talk to a planner before giving anything away.

This is a common area of confusion.  The IRS gift exemption, which addresses income tax thresholds for gifts, is independent of Medicaid guidelines.  Therefore, Medicaid might consider a gift that complies with IRS guidelines a penalty-causing divestment.

Pennsylvania’s Community HealthChoices program can pay for in-home care and certain community services for people who qualify medically and financially.

Coverage for assisted living and personal care homes is more limited: Medicaid may cover some care services, but generally not room and board. We can help you understand which options fit your family’s situation.

Protecting Your Home & Spouse

My wife will continue to live in our home. Will the law protect her?

Medicaid has rules that protect the spouse of a Medicaid recipient from becoming impoverished.  The allowable asset limit is much higher when there is a “community spouse”, although these limits vary by state.  Many families don’t know about these protections and unnecessarily deplete assets before applying for Medicaid.

Pennsylvania protects the spouse who remains at home, called the “community spouse.” In 2026, the community spouse may keep between $32,532 and $162,660 in countable assets, depending on the couple’s total assets at the start of care. They may also be entitled to part of the nursing home spouse’s income if their own income is low.

These protections are often misunderstood, and many couples spend down far more than necessary before applying.

Most families asking “will Medicaid take my house” can keep it with proper planning. Your home is usually exempt while you’re alive if your spouse lives there, or if you intend to return home. For a single applicant, the home’s equity must be under $752,000 (2026) for it to stay exempt.

But an exempt home can still be subject to Pennsylvania’s estate recovery program after the Medicaid recipient passes away. See our guide to Medicaid and your home for how families protect it.

Transferring a home during the five-year lookback usually creates a penalty. However, federal and Pennsylvania rules allow certain transfers without penalty. Examples include a transfer to a spouse, to a child who is blind or disabled, or to a “caregiver child” who lived in the home and provided care that kept the parent out of a nursing home for at least two years. These exceptions have strict documentation requirements.

We help families identify whether one applies before anything is transferred.

Pennsylvania’s Estate Recovery Program can seek repayment from the estate of a Medicaid recipient who was 55 or older, for nursing home and certain other long-term care services. Pennsylvania defers recovery while a surviving spouse is living, or while there is a child who is under 21, blind or permanently disabled. Hardship waivers may also be available.

Estate recovery is one of the most important and least understood parts of Medicaid planning, and families should consider it before they spend down assets.

See our guide to Medicaid and your home for how estate recovery affects the house specifically.

The Application Process

What documents do I need to apply for Medicaid in Pennsylvania?

The County Assistance Office typically requires proof of identity and citizenship, income statements, up to 60 months of bank and investment statements, life insurance policies, property deeds, vehicle titles, burial arrangements, and explanations for large deposits or withdrawals.

Missing or incomplete documents most often delay applications. We create a checklist specific to your situation and help gather and organize everything before filing.

It varies by county and by how complete the application is. Caseworkers can decide straightforward cases within weeks. Applications with incomplete records or questions about past transactions can take several months.

A complete, well-documented application submitted the first time is the best way to avoid long delays.

A denial isn’t necessarily final. Many denials result from missing documentation or misunderstandings that can be corrected. Pennsylvania allows applicants to request a fair hearing, but there are strict deadlines, so act quickly once a denial notice arrives.
We provide Medicaid advocacy to help families respond to requests from the County Assistance Office and pursue a denial.

No.  There’s a misunderstanding that Medicaid recipients receive a lesser quality of care than nursing home residents who pay privately.  There are regulations in place to ensure that this does not happen.  Federal and state regulations require nursing homes to provide the same standard of care to every resident, regardless of how their care is paid for