PA 600L - Pennsylvania Department of Human Services 2026

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The document is an application form for Medical Assistance (Medicaid) financial eligibility for long-term care, supports, and services. It outlines the necessary information required from applicants, including personal details, income, resources, and verification of assets. The form emphasizes the importance of providing accurate information and the consequences of asset transfers within the past 60 months. It also includes instructions for completing the application, rights and responsibilities of applicants, and information on how to appeal decisions regarding eligibility.

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Click ‘Get Form’ to open the PA 600L in the editor.
Begin by filling out your personal information in the designated fields, including your name, Social Security number, and birth date. Ensure all details are accurate and legible.
Next, indicate your marital status and provide information about your spouse if applicable. If you have dependents, include their details as well.
Proceed to the income section where you will list all sources of income for yourself and any household members. Be thorough to avoid delays in processing.
In the resources section, detail any assets such as real estate or vehicles. If necessary, attach additional documentation to support your claims.
Review all entered information for accuracy. Use our platform's features to strike out incorrect entries and replace them with updated information.
Once completed, save your form and either print it for mailing or submit it electronically through our platform if available.

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