PA 1572 Spousal Resource Assessment Form: When to File and How It Protects the Community Spouse

What the PA 1572 Does

When one spouse enters a nursing facility or qualifies for a Community HealthChoices waiver while the other remains living at home, Pennsylvania Medicaid doesn't require the community spouse to go broke. The spousal impoverishment protections guarantee them a share of the couple's combined assets — the Community Spouse Resource Allowance.

Form PA 1572 — the Resource Assessment Form — documents the asset snapshot and is used to determine exactly how much the community spouse gets to keep. Submit it to the local County Assistance Office.

How the Snapshot Works

The PA 1572 establishes the couple's combined countable assets as of one specific date: the first day of continuous institutionalization or the date of a waiver clinical assessment. This is the snapshot date.

Once the CAO receives the completed PA 1572, it calculates the CSRA using these federal rules (2026 figures):

• The community spouse keeps 50% of the couple's combined countable resources
• That share cannot fall below the federal minimum floor of $32,532
• It cannot exceed the federal maximum cap of $162,660
• If 50% of combined assets is less than $32,532, the community spouse keeps everything up to $32,532

The institutionalized spouse retains their individual asset allowance — either $2,400 (for Medicaid nursing home) or $8,000 (for the CHC waiver). Everything above the CSRA plus the individual allowance must be spent down before Medicaid approves the application.

When to File

File the PA 1572 as early as possible — ideally within the first few days of a nursing facility admission or immediately after the Area Agency on Aging completes the waiver functional assessment.

This timing matters because the snapshot date is the first day of continuous institutionalization or the date of the waiver clinical assessment — not the date you fill out the form. Filing early documents the correct date before joint resources are spent on care.

If you wait three months and $30,000 has gone to private-pay nursing home bills in the interim, that later depletion does not change the snapshot date; the relevant asset figure remains the resources on the applicable admission or assessment date.

What Counts as a Countable Asset

The PA 1572 requires you to list the couple's combined resources. Countable assets include:

• Bank accounts (checking, savings, CDs, money market) — including joint accounts
• Stocks, bonds, mutual funds, brokerage accounts
• The applicant spouse's IRAs, 401(k)s, and other retirement accounts
• Cash value of life insurance policies with a face value over $1,500
• Real property other than the primary residence
• Vehicles beyond the one the community spouse uses for transportation

Exempt (not counted):

• The primary residence (if the community spouse or a dependent lives there, or if the institutionalized spouse intends to return)
• The community spouse's sole-name IRA or 401(k) — this is a major Pennsylvania-specific protection that many states don't offer
• One vehicle
• Household furnishings and personal belongings
• Irrevocable burial reserves (capped at 125% of the county average funeral cost)
• Prepaid funeral contracts

Filing the Form

The PA 1572 goes to the County Assistance Office in the county where the nursing facility is located, or, for HCBS, where the individual receives HCBS — not where the community spouse lives, if they're in a different county. You can get the form from the CAO or download it from the DHS website.

The form itself asks for straightforward financial information: account balances, property values, insurance policies, and vehicle details. Attach photocopies of supporting documentation for every resource — do not send originals; the assessment cannot be completed without verification.

After processing, the CAO issues a written resource assessment notice stating the CSRA amount. Keep this document. It establishes the community spouse's protected share and becomes the reference point for the entire Medicaid application.

The Income Deflection Piece

Separately, Pennsylvania protects the community spouse's income. If the community spouse's own monthly income falls below the Minimum Monthly Maintenance Needs Allowance — $2,705 in the 2026-2027 program year — the institutionalized spouse's income can be deflected to make up the difference.

This deflection reduces the institutionalized spouse's patient liability (the amount they pay to the nursing home each month), keeping more money in the household. If the community spouse has high shelter costs, an excess shelter allowance can push the maximum deflection up to $4,066.50 per month.

The PA 1572 establishes the resource baseline; income deflection is a separate protection based on the community spouse's income and shelter costs.

Common Mistakes

Filing too late. Delaying the form can delay the written resource assessment and spend-down planning. It does not change the applicable snapshot date, which is based on the admission or waiver assessment date.

Forgetting the community spouse's IRA exemption. List the community spouse's sole-name IRA or 401(k) on the PA 1572 as the form requires, but identify it as exempt rather than countable. Pennsylvania excludes it from the standard countable-resource calculation.

Not requesting a fair hearing when income protections are insufficient. If exceptional circumstances cause significant financial duress, Pennsylvania says the couple may request an increase in the community spouse monthly maintenance needs allowance through a Medicaid application and hearing.

The Pennsylvania Medicaid Long-Term Care & Asset Protection Guide walks through the full PA 1572 filing process with a spousal protection calculator worksheet that maps every countable and exempt asset, calculates the CSRA, and flags income deflection opportunities.

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