County Assistance Office Medicaid Application in Pennsylvania

The CAO's Role in Long-Term Care Medicaid

The County Assistance Office (CAO) handles the financial eligibility determination for Medicaid long-term care in Pennsylvania. After the Independent Enrollment Broker confirms your parent is clinically eligible (Nursing Facility Clinically Eligible through the Functional Eligibility Determination), the application moves to the CAO for the income and asset review.

Every Pennsylvania county has a CAO. The application can be submitted in person at the local office, by mail, or through the state's COMPASS online portal. For long-term care Medicaid specifically, the form is the PA 600L (Application for Long-Term Care/Waiver Services).

The CAO caseworker's job is to verify whether the applicant meets the financial thresholds. For 2026, that means gross monthly income at or below $2,982 (the Special Income Limit) and countable assets at or below $8,000 (Tier 1) or $2,400 (Tier 2, if income exceeds the SIL). The caseworker also conducts the 60-month lookback review for asset transfers.

How Long the Process Takes

There is no reliable 30-to-45-day promise for a long-term-care case. The broader enrollment process commonly takes 8 to 12 weeks, and documentation requests can push complex cases to 90 days or more.

The most common timeline extension: the caseworker sends a verification request asking for additional financial documents — a missing bank statement, an explanation for a large withdrawal, documentation of a closed account. Follow the response deadline printed on each verification request; do not assume every request gives 30 days. Missing it can lead to denial or closure and may require an appeal or a new application.

Families with complex financial situations — multiple bank accounts, prior asset transfers, real estate, or income from multiple sources — should expect at least one round of verification requests. Some applications go through two or three rounds, pushing the total timeline to 90 days or more.

You can track submitted applications through COMPASS or myCOMPASS. If information is missing or unclear, contact the CAO for the county handling the application.

What to Have Ready Before Filing

The documentation the CAO requires for the lookback review is extensive. Gathering it after filing — in response to verification requests — adds weeks. Having everything organized before you submit the PA 600L is the single most effective way to shorten the processing time.

60 months of bank statements for every account the applicant owns or co-owns. This includes checking accounts, savings accounts, money market accounts, certificates of deposit, and any account that was open at any point during the 60-month period — even if it has since been closed.

Income documentation. Social Security benefit verification letter (from SSA, not a bank deposit printout), pension statements, annuity payment schedules, rental income documentation, investment income statements.

Asset documentation. Current balances on all accounts, vehicle titles and values, life insurance policies with cash value statements (cash value over $1,500 is countable), burial fund documentation, and property deeds.

Transfer documentation. If any assets were transferred, gifted, or sold below market value during the 60-month lookback period, you need documentation for each transaction: what was transferred, to whom, the date, and the value. The CAO may request documentation to determine whether a transfer was uncompensated; an undocumented transaction can lead to further verification and a penalty if treated as uncompensated.

Spousal documentation. If the applicant has a community spouse, the CAO needs documentation of both spouses' assets and income as of the application date to calculate the Community Spouse Resource Allowance.

Common Mistakes That Cause Denials or Delays

Incomplete bank statements. The caseworker needs every page of every statement for 60 consecutive months. A single missing month — especially for a closed account — will trigger a verification request. Request statements from the bank before filing. Banks may charge for historical statements, but the cost is trivial compared to the delays.

Unexplained large transactions. Any withdrawal, transfer, or deposit that looks unusual relative to the applicant's normal activity will draw scrutiny. A $3,000 cash withdrawal for home repairs needs a receipt. A $10,000 transfer to a child needs documentation showing it was a loan repayment, not a gift. The caseworker is looking for potential lookback violations, and unexplained transactions are treated as uncompensated transfers until documented otherwise.

Filing without legal authority. An adult child who has not been named as power of attorney cannot legally sign the PA 600L on behalf of the applicant, cannot authorize the release of financial records, and cannot respond to verification requests. If your parent lacks the cognitive capacity to manage the application themselves and no POA is in place, the application stalls until either a POA is executed (if the parent still has capacity) or a guardianship is established through Orphans' Court.

Assuming the Medicaid start date is the application date. Medicaid may be available for a retroactive period only if the applicant met all eligibility requirements for that period. Use the written eligibility notice and the CAO to confirm the effective date; do not assume it is the filing date.

After Approval

Once the CAO issues the eligibility notice (Form PA 162), the applicant selects a Community HealthChoices managed care organization — AmeriHealth Caritas, PA Health & Wellness, or UPMC Community HealthChoices — through the Independent Enrollment Broker. The MCO assigns a service coordinator who builds the care plan.

If the CAO denies the application, you have 30 calendar days from the date on the written notice to file an appeal with the DHS Bureau of Hearings and Appeals. If benefits were previously active and are being reduced or terminated, you must file within 13 calendar days of the notice date to continue receiving benefits during the appeal.

The Choosing Care in Pennsylvania guide includes a financial worksheet that helps organize all documentation before filing and an enrollment timeline tracker that maps each step from PA 600L submission through plan selection. It covers the lookback audit process, the spousal resource allowance calculation, and the appeal procedures if the CAO denies the application.

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