Pennsylvania Families
Every other option, explained honestly — VA benefits, long-term care insurance, spend-down, and what private pay actually costs.
You did the research. You found out Pennsylvania's Medicaid program covers in-home care. And then you got to the numbers and discovered your mother has $42,000 in savings, or your father's pension puts him $300 over the income limit, and just like that the door closed.
I want to tell you something before we go further: not qualifying is the most common outcome in this county, and it is not the end of the conversation. Montgomery County's median household income is around $114,000 and most older adults here own their homes. The program was built for people with almost nothing. Being told no usually means your family worked hard and saved, which is a strange thing to be penalised for and a real thing to have to plan around.
I spent years assessing whether Pennsylvania families qualified for Medicaid-funded care, sitting at kitchen tables doing exactly this math. This page is everything I know about what comes next.
Families get told no by someone who guessed. Before you plan around a denial, confirm it.
The three tests for Community HealthChoices, Pennsylvania's Medicaid long-term care program, apply to the person receiving care — not to you, not to your household:
The house. A primary residence is generally not a countable asset.
Your income. Yours doesn't count. Only your parent's.
Owning a car. One vehicle is generally excluded.
A small pension. Being over the income limit doesn't always end it — Pennsylvania has mechanisms for excess income, and they're worth asking about specifically.
If you haven't had a formal determination, call the Pennsylvania Independent Enrollment Broker at 1-877-550-4227. A real answer costs nothing and takes one phone call.
And if your parent does qualify, a family member can often be paid to provide the care. I've written about how that works in Getting Paid to Care for a Parent in Pennsylvania — including the parts most articles leave out.
The most under-claimed money in Pennsylvania.
If your parent served, or is the surviving spouse of someone who did, start here. Aid & Attendance is a VA pension benefit that pays a monthly amount above the basic pension for veterans who need help with daily activities — and it can be used for in-home care.
Why it's under-claimed: the application is genuinely confusing, the name doesn't describe what it does, and many veterans assume it's only for service-connected disabilities. It isn't.
Roughly who's eligible: wartime service, an honourable discharge, a demonstrated need for assistance with daily activities, and income and asset limits that are considerably more generous than Medicaid's.
Accredited representatives do this at no cost, and charging for claim preparation is prohibited. Get help free through your county Veterans Affairs office, or an accredited Veterans Service Officer through the VFW, American Legion, or AMVETS.
This is often the single best answer for families who miss Medicaid by too much. It's worth a phone call even if you think it's a long shot.
Check the file cabinet.
People buy these policies in their fifties and forget them entirely. Before assuming there's nothing, look for paperwork, check old bank statements for recurring premium payments, and ask your parent's financial advisor.
The elimination period. Most policies require 30, 60, or 90 days of paid care before benefits begin. You pay out of pocket during that window, and that period usually starts when care starts — so starting sooner starts the clock sooner.
The daily or monthly benefit cap. Older policies often pay $100–$200 per day. That may cover part of your need, not all of it.
Whether it covers home care at all. Some older policies only cover facility care. Newer ones usually include home care, but read it.
Whether it requires a licensed agency. Many policies will only reimburse care from a licensed provider — which means hiring a neighbour privately may not be reimbursable, even at a lower rate.
That last point matters more than families expect. If a policy requires licensed care, our agency services satisfy that requirement and we can provide the documentation insurers ask for.
Legitimate, but get advice.
If your parent is over the asset limit, they may become eligible after those assets are spent on care and legitimate expenses. This is a normal, lawful path. Many families end up here.
What is generally allowed: paying for care, medical expenses, home modifications for safety, paying off debt, funeral pre-planning, home repairs.
Giving money to family, transferring the house to children, or "spending down" by moving assets around. Medicaid applies a five-year look-back to transfers, and gifts inside that window create penalty periods that can be far worse than simply not qualifying.
Do not attempt to engineer eligibility from internet advice, including mine. This is the one area where an elder law attorney is genuinely worth the fee — a consultation costs a few hundred dollars and routinely saves families tens of thousands.
What I can help with is the honest arithmetic of what care actually costs during a spend-down, so you can plan the timeline rather than discover it.
The OBRA waiver serves adults under 60 with physical disabilities who need long-term care, and uses the same participant-directed model as Community HealthChoices — meaning a family member can often be paid.
Your Area Agency on Aging administers non-Medicaid programs, including some respite funding, that have different and often looser eligibility rules. In our region that's the Montgomery County Office of Senior Services. Worth a call regardless of your Medicaid answer.
PACE and PACENET help with prescription costs, which frees household money for care.
LIFE programs combine medical and personal care for people who need nursing-home-level care but want to stay home.
Not sure which of these applies to your situation? That's exactly what benefits and funding navigation is for.
Here's where most families land, and where the biggest misconception lives.
Families imagine full-time care and a bill they can't survive. In practice, most families who hire privately start with far fewer hours than they expected — enough to work, or sleep, or attend their own medical appointments.
Through an agency, where the caregiver is an employee and the agency carries payroll taxes, workers' compensation, and insurance, our rates start at $34 an hour for companion care and rise with the level of care needed. One hourly rate covering everything, with a four-hour minimum per visit.
There's also a second model. Pennsylvania licenses both home care agencies and home care registries, and we hold both. Under Family-Led Care, we refer independent contractors from our cleared roster, you choose who you want, and you agree the rate with them directly and pay them directly. Contractors in this region typically agree rates between $22 and $35 an hour. We charge a one-time $400 setup fee and $30 for each day care is provided.
Which one is right depends on your situation, and we'll tell you honestly. See how both models work and what each costs →
Start with the highest-value hours. Mornings are usually hardest — the getting up, the bathing, the first medications. Two mornings a week of real help changes the week more than seven scattered hours would.
Combine it with family. Paid care Tuesday and Thursday, siblings the rest. You don't have to buy everything.
Split it among adult children. Three siblings contributing is a different conversation from one adult child paying alone.
Use short-term care around specific events. After a hospital discharge, after a surgery, during a treatment course. Sometimes six weeks is all that's needed.
Fix the house instead of buying more hours. A grab bar and better stair lighting can prevent the fall that costs everything. Our home safety assessment is $275 and comes with a written report within 48 hours listing every hazard by risk and what it would cost to fix.
Get the formal denial before planning around it. Guessing costs families months.
Check for VA benefits even if you doubt it. It's the most missed money in this state.
See an elder law attorney if there are real assets. Once, early. Not after a transfer.
Start smaller than you think. Nearly every family that hires care tells me afterwards they wish they'd started sooner, and none say they wish they'd waited for a crisis.
And ask early. The families who reach out before an emergency always have more options than the ones who wait. I've never once had someone tell me they called too soon.
Why This Page Exists
Gilgal Home Care & Registry is licensed by the Pennsylvania Department of Health as both a home care agency and a home care registry. We earn nothing from VA benefits, from Medicaid, or from telling you that your family may not need to hire anyone yet.
I wrote this because families ask me these questions every week and get either silence or a sales pitch, and both are worse than the truth.
The first call is free, fifteen minutes, and there's nothing to sign.
📅 Book a Free Call 📞 (484) 202-7837Or email care@gilgalhomecare.org · Read the full FAQ
This page reflects Pennsylvania program rules as of 2026. Income and asset limits change annually, and eligibility decisions are made by the Commonwealth, not by us. Nothing here is legal, tax, or financial advice; for complex financial situations, consult an elder law attorney.
A Pennsylvania licensed home care agency and registry — connecting families with qualified caregivers, and equipping the next generation of care professionals.
© 2026 Gilgal Home Care & Registry. All rights reserved. King of Prussia, PA 19406.
Licensed by the Pennsylvania Department of Health under 28 Pa. Code Chapter 611 as both a home care agency and a home care registry. Family-Led Care is our name for the registry model: Gilgal refers independent contractors and does not employ, supervise, or set the compensation of the contractor you select.
