Pa 1572 resource assessment-2026

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The document provides instructions for completing the Resource Assessment Form (PA 1572) for couples where one spouse is in a nursing facility or receiving Home and Community Based Services (HCBS). It outlines the importance of protecting a portion of the couple's resources under Medical Assistance guidelines, details the verification process for various resources, and emphasizes that this form is not an application for Medical Assistance. The document also includes information on language assistance and the necessary steps to ensure accurate completion of the form.

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Click ‘Get Form’ to open the PA 1572 Resource Assessment in our editor.
Begin by filling in your personal information, including your last name, first name, and date of birth. Ensure accuracy as this information is crucial for processing.
Next, provide details about your spouse, including their name and social security number. This section is vital for determining resource allocation.
In the resources section, list all assets owned individually or jointly. Use the provided resource codes to categorize each asset accurately.
Attach photocopies of verification documents for each resource listed. Remember not to send original documents as they will not be returned.
Review the checklist at the end of the form to ensure all necessary information and documentation are included before submitting.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (98 Votes)
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What is the community spouse resource allowance in PA?

There is a maximum and a minimum countable Resource Allowance that can be kept by the community spouse. In 2025, the maximum Resource Allowance is $157,920, while the minimum Resource Allowance is $31,584.

What is a PA 1572?

resources as possible for the spouse in the community, it is important that a detailed resource assessment be. completed as soon as one spouse enters a long-term care. facility before joint resources are expended on care. A resource assessment form (PA 1572) can be obtained from the long-term care facility.

What is a PA-4 form for Medicaid?

The PA-4 is to be completed by the attending physician for individuals seeking long term care services including Medicaid home and community based program. It is a statement, which substantiates the individuals diagnosis and describes the individuals related care needs.

What is a PA 1572 form?

The purpose of this Resource Assessment Form is to determine how much of a married couples total resources may be protected or set aside for the community spouse, and how much, if any, must be spent before the individual in the nursing facility or assessed eligible for HCBS may be eligible for Medical Assistance

What is the importance of Form 1572?

A form that must be filed by an investigator running a clinical trial to study a new drug or agent. The investigator agrees to follow the U.S. Food and Drug Administration (FDA) Code of Federal Regulations for the clinical trial.

pa 1572

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How to apply for long term care Medicaid in PA?

You can apply for long-term services by phone or online: Phone: Call our Independent Enrollment Broker (IEB) at 1-877-550-4227. Phone: Call the Consumer Services Center at 1-866-550-4355. Online: Apply via COMPASS, Pennsylvanias benefit management website.