The 2026 limit and how it’s counted

The financial rules for the Community HealthChoices (CHC) waiver are strict. In 2026, the income limit is $2,982 per month. This figure equals 300% of the Supplemental Security Income (SSI) Federal Benefit Rate.

The County Assistance Office (CAO) reviews your financial information to determine PA Medicaid home care eligibility. They usually count gross income.

Because there are very few allowed deductions, you should expect the CAO to use the gross amount. Only the applicant’s income counts toward this limit.

If your loved one is married, the CAO ignores the spouse’s income entirely when determining waiver eligibility.

If your loved one does not need long-term services and supports but is on Medicare and financially eligible, they do not need the waiver. They apply for standard Medicaid through the CAO using the COMPASS website, calling 1-866-550-4355, or visiting in person.

Option 1: A trust for excess income (income trust)

If gross income is above $2,982, your loved one might still qualify for PA Medicaid for home care by using an income trust.

An income trust allows an applicant to redirect excess income into a special account. The Pennsylvania Health Law Project (PHLP) explains this process in their factsheet, “Accessing Home and Community-Based Services When Income Appears Too High.”

The trust must be set up correctly to meet state requirements. Because the rules for these trusts are complex, you should contact an elder law attorney or the PHLP for help.

You can reach the PHLP Helpline at 1-800-274-3258. They offer free legal help for Office of Long Term Living (OLTL) waivers.

Option 2: MAWD and Workers with Job Success

Another option exists for younger individuals who earn money from working. If the applicant is under age 65 and working, they might qualify through Medical Assistance for Workers with Disabilities (MAWD).

Workers with Job Success (WJS) is an expanded MAWD category. Both have higher income and resource limits than the waiver, and a person who qualifies financially for MAWD or WJS can get waiver services if they are also functionally eligible.

The CAO reviews the application to see if the applicant meets the MAWD requirements.

Need help setting up home care services in Philadelphia or surrounding counties? Call New Century Home Care at 215-974-0000 or fill out our contact form (choose “I am a client” then “I need services”). Our office staff speaks English, Russian, and Ukrainian.

What about “spend down”?

You may hear the term “spend down” when reading about Medicaid. For the CHC waiver, PHLP describes two routes for people over the income limit: an income trust, or MAWD / Workers with Job Success. If someone suggests a different approach, ask PHLP whether any other eligibility category applies before acting on it.

Where income is checked in the application

Income is reviewed at the end of the CHC waiver application. First the doctor’s certification and the PCA assessor’s Functional Eligibility Determination decide whether your loved one is nursing facility clinically eligible. Then the IEB sends form PA 1768 to the County Assistance Office, which reviews income, assets and the 5-year look-back. Once approved, Medicaid coverage begins on the date of application.

If assets (not income) are the problem

Income is only one part of the financial review. The CAO also checks resources, which are your loved one’s assets.

The state excludes certain assets from this count. The CAO will not count the home the applicant lives in or one motor vehicle.

They also exclude irrevocable burial accounts, life insurance without cash value, and the non-applying spouse’s pension or retirement account.

During the financial review, the CAO looks at the past five years of financial records. They check tax returns and bank records for any transfers made for less than fair market value.

This review is known as the 5-year look-back rule. Transfers can result in a penalty period of ineligibility, and the length of the penalty depends on the amount transferred.

If the CAO denies the application due to income or assets, you can appeal. You must request a Department of Human Services (DHS) Fair Hearing in writing within 30 days of the notice.

Estate recovery rules

Families with higher incomes often worry about protecting their property. Pennsylvania operates an Estate Recovery program for Medicaid recipients.

The state can recover the costs of Home and Community-Based Services (HCBS) waiver services, nursing home care, and related hospital or prescription costs. They recover these funds from the estate of a recipient who was 55 or older when they received care.

The state considers the total value of the estate. However, they factor in whether a surviving spouse or dependents still live in the home, and you can apply for a hardship waiver.

Other ways to pay for care at home

If your loved one cannot qualify for Medicaid, you will need to explore other funding methods. You can pay for non-medical home care out of pocket.

New Century Home Care provides personal care, companion care, and homemaker services. We serve Philadelphia, Bucks, Montgomery, Delaware, and Chester counties.

Our services include mobility assistance, respite care, and specialized support for conditions like dementia, Parkinson’s, and stroke recovery.

You might also use private insurance policies or veteran programs. If you want to review all potential funding sources, check our guide on ways to pay for senior care.

You can also read about how long-term care insurance policies work, or learn about VA benefits for home care.

Ready to start home care services? Call New Century Home Care at 215-974-0000 or fill out our contact form. Choose “I am a client” and “I need services” to get started.