PHLP’s Nursing Home Diversion and Transition Project

Residents of nursing facilities have experienced and died from COVID-19 at an alarming rate, far outpacing people in the community.  Residents of these facilities, people who are at risk of nursing home placement, and their families are terrified that staying in or moving to a nursing home poses an unacceptable risk to their health and life because of COVID-19.   

To help people with disabilities and seniors who want to leave or avoid having to go to a nursing home where their risk of COVID-19 infection is substantially increased, PHLP is intensifying its efforts to help people access services that can support them in the community.  This work includes advocacy for expedited transitions from nursing homes, accelerated Medicaid waiver eligibility decisions, and assisting people in becoming financially eligible for Medicaid waiver through qualified income spend down trusts.   

PHLP’s income spend down trust work addresses a bias towards institutionalization over community living; income is counted differently depending on whether the Medicaid applicant seeks care in a nursing facility and at home through a waiver.  All Medicaid waivers in Pennsylvania have a monthly income limit of $2,349 (applicant’s income only).  As a practical matter, there is no income limit for Medicaid nursing home coverage.  Residents can spend down their income to pay for the nursing home, which then provides for all the resident’s needs, and a married nursing home resident can divert some of their income to their spouse in the community.  This means someone whose income is well over the $2,349 monthly waiver limit can have Medicaid cover their nursing home expenses, but is not able to live in the community with Medicaid-funded services and supports.  To remedy this inequity, PHLP can set up income spenddown trusts, recognized by the Pennsylvania Department of Human Services, for people whose income is $500 or less over the Medicaid waiver limit.   

If you are working with consumers wishing to leave a nursing facility or avoid placement in a nursing facility, we urge them to contact the PHLP Helpline at 1-800-274-3258 or  We want to help them through the process and assist those who may appear over-income for a waiver in becoming eligible.