(Medicaid) Financial Eligibility Application for Long Term Care - dpw state pa: Fill out & sign online

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out (Medicaid) Financial Eligibility Application for Long Term Care - dpw state pa with DocHub

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open it in the editor.
Begin by checking the appropriate boxes for the type of care you are applying for: either 'Care in a Facility' or 'Home and Community Waiver Services'. If applicable, specify the type/name of waiver/service.
Fill in your personal information in the unshaded sections, including your name, address, and contact details. Ensure that all entries are clear and legible.
Complete the income and resource sections thoroughly. This includes detailing any assets owned within the past 60 months, as well as providing verification documents if necessary.
Review all sections carefully to ensure accuracy. If you have a spouse or dependents, include their information where required.
Once completed, submit the application by bringing it to your county assistance office or mailing it as instructed. Keep a copy for your records.

Start using our platform today to simplify your application process for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

What are the asset limits for medical assistance Medicaid long-term care benefits in PA 2025?

In 2025, a single Nursing Home Medicaid applicant in Pennsylvania must meet the following criteria: 1) Income under $2,901 / month 2) Assets under $2,000 3) Require a Nursing Home Level of Care.

Does Medicaid pay for nursing home care in Pennsylvania?

Pennsylvanias Medicaid program will pay for a nursing home or home care if you have limited income and assets and your doctor certifies that you need the care.

How long does it take to get approved for Medicaid in PA?

Verification and Approval Once you submit your Medicaid application, it will undergo a verification process to check your information and ensure everything is correct. Usually, youll hear back within about 30 days, but it can sometimes take a bit longer.

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.