Income and Asset Limits for PA Waiver Services in 2025
Qualifying for Home and Community-Based Services (HCBS) waivers in Pennsylvania involves meeting both clinical and financial eligibility requirements. The financial criteria, including income and asset limits, are based on federal guidelines and change annually. The most common HCBS programs, like the Community HealthChoices (CHC) Waiver, generally follow the same financial rules, though some specific programs have variations.
General Income Rules for HCBS Waivers
For a single applicant seeking most long-term care waivers in Pennsylvania in 2025, the monthly gross income limit is $2,901. This figure is typically 300% of the Federal Benefit Rate (FBR) and is adjusted at the start of each year to account for inflation. The key here is that only the applicant's income is counted toward this limit, which provides a significant advantage for married couples where only one spouse is seeking services.
Here are some important details about how income is calculated:
- Gross Income: The state considers your total income before taxes and other deductions are taken out.
- Countable Income: This includes most sources of income, such as Social Security, pensions, IRA withdrawals, and rental income.
- Non-Countable Income: Certain payments are excluded, such as the Aid and Attendance portion of a VA benefit.
Asset Limits for PA Waivers
Along with income, there are also limits on the value of a person's countable resources or assets. The 2025 asset limit for a single applicant varies depending on their income level:
- Income at or below $2,901/month: The resource limit is $8,000.
- Income over $2,901/month: For those who use an income spend-down trust, the resource limit is $2,400.
Exempt or non-countable assets typically include the primary residence (with some equity limits), one vehicle, personal belongings, and burial plots.
Special Programs with Different Income Criteria
Some waiver-like programs in PA have different income requirements, especially for those who are working with a disability. The Medical Assistance for Workers with Disabilities (MAWD) program is a notable example.
- MAWD Eligibility: To qualify for MAWD, an applicant's countable income must be below 250% of the Federal Poverty Income Guidelines, and resources must be under $10,000.
- Workers with Job Success (WJS): This category is for individuals who exceed the MAWD income limit but have been enrolled in MAWD for 12 consecutive months. The income limits are higher, and there are no resource limits once enrolled.
Comparison of Waiver Program Financial Requirements (2025)
| Feature | Community HealthChoices Waiver | MAWD for Workers with Disabilities |
|---|---|---|
| Primary Purpose | Long-term services for seniors and individuals with physical disabilities. | Full Medicaid for working individuals with disabilities. |
| Single Applicant Income Limit | $2,901 per month (300% FBR). | < 250% of Federal Poverty Income Guidelines. |
| Single Applicant Asset Limit | $8,000 (if income is at or below limit). | $10,000. |
| Married Applicant Income Rules | Only the applicant's income is counted. | Income is considered as a couple for certain rules. |
| Income Spend-Down | Possible for those with income slightly over the limit using a trust. | Not applicable, as eligibility is based on a different income scale. |
What if Your Income is Above the Limit?
If a single applicant's gross monthly income is above the $2,901 limit, they may still be able to qualify through an income spend-down process. This is often facilitated through the use of a special type of trust, also known as a Qualified Income Trust.
- How it works: The applicant deposits their excess income into a specific trust, which is often managed by a non-profit company.
- Complexity: The process for utilizing an income spend-down is complex and typically requires the assistance of an elder law attorney to navigate correctly.
Conclusion
The income limit for most PA waiver services in 2025 is $2,901 per month for a single applicant. This standard applies primarily to the Community HealthChoices waiver and other long-term care programs. Eligibility is also contingent on meeting asset limits, which can differ based on income levels. Alternative programs like Medical Assistance for Workers with Disabilities (MAWD) offer different pathways for working individuals. Understanding these specific financial rules and whether special options like an income spend-down trust apply is crucial for determining eligibility. Given the complexity, consulting with a qualified professional or the County Assistance Office is highly recommended.
Learn more about Pennsylvania's Medicaid programs for long-term care from MedicaidPlanningAssistance.org.
