Updated August 27, 2026. Quick answer: Pennsylvania measures medically needy eligibility over half a year rather than a month: “For medically needy only (MNO) categories, the limit is $2,550 (semi-annual net income)”. And for long-term care it allows a deduction large enough to change most cases: “If your income exceeds 300 percent of the FBR limit, the anticipated cost of long-term care facility services for a 6-month period is an allowable medical expense deduction to reduce monthly income.”
Same question in other states: Hawaii Medicaid Spenddown, Idaho Medicaid Excess Income Rule and Illinois Medicaid Spenddown.
What Pennsylvania requires
| What the state sets out | What it says |
|---|---|
| The medically needy only (MNO) limit | $2,550, semi-annual net income |
| What the state says | “For medically needy only (MNO) categories, the limit is $2,550 (semi-annual net income)” |
| The period | six months, not one |
| The long-term care deduction | “If your income exceeds 300 percent of the FBR limit, the anticipated cost of long-term care facility services for a 6-month period is an allowable medical expense deduction to reduce monthly income.” |
| When the deduction applies | where income exceeds 300 percent of the FBR limit |
How it works in practice
- The semi-annual basis is the first thing to get right. The MNO limit is “$2,550 (semi-annual net income)”, so comparing it against a monthly income figure will be wrong by a factor of six.
- The long-term care deduction is the provision that makes most nursing home applications work: “If your income exceeds 300 percent of the FBR limit, the anticipated cost of long-term care facility services for a 6-month period is an allowable medical expense deduction to reduce monthly income.” The anticipated cost of care is itself the deduction, and it is usually far larger than the excess income.
- The deduction is conditional on being over the 300%-of-FBR threshold, so it is aimed specifically at applicants who would otherwise be shut out by the income cap.
The mechanism itself — why an income cap exists and what the trust must contain — is explained on the income-cap and Miller trust page. This page is the Pennsylvania record.
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How our partner relationships workWhat this page does not settle
- Pennsylvania publishes the current FBR-linked figures separately and they change with the federal benefit rate. This page quotes only the MNO limit the state stated on the source read.
- This page reads one source: Pennsylvania DHS, Medicaid payment for long-term care. It is the state’s own publication on this rule, but no state puts its whole treatment of excess income in a single document, and a detail that decides your case may sit in one this page did not read.
- A spend-down fixes an income problem and nothing else. The resource test, the level-of-care test and the transfer-of-assets look-back are separate hurdles, each decided on your own file, and meeting this rule does not clear any of them.
- Every quotation here was read against the source on August 27, 2026. States revise these rules, and a figure or a section number can move without the page around it changing. Open the source before you rely on a detail.
Eligibility is decided by the state agency on the whole file, not by one rule on one page. Nothing here is legal advice, and no one should move, retitle or assign income on the strength of a web page.
Sources
The source above was retrieved and read against the state text on August 27, 2026. Every quotation on this page was checked against those bytes.
Related: Pennsylvania’s Medicaid home equity limit for a single applicant with no spouse or dependent child at home.
Related: Pennsylvania’s Medicaid Personal Needs Allowance; the amount a nursing-facility resident keeps from their own income each month.
Related: use the Medicaid spend-down calculator to estimate how much you would need to spend down to qualify for long-term-care Medicaid in your state.