For many older adults, Medicaid Assistance (MA) is an essential lifeline that plays a pivotal role when living at home is no longer a safe option. Many skilled nursing facilities in Pennsylvania strive to provide high-quality care while navigating significant financial and regulatory challenges. Due to uncertainty around the approval of pending MA applications, facilities face challenges to maintain the financial stability necessary to continue serving residents effectively and more importantly remain open.
 
As of June 2025, at least 30 skilled nursing facilities have closed in Pennsylvania since the beginning of 2024, and many have filed for bankruptcy. These closures have resulted in the loss of approximately thousands of certified nursing home beds statewide. MA pendency has been a contributing factor for many facility owners in Pennsylvania, particularly the small owned and operated facilities who are not large enough to be able to carry the cost of care while waiting for reimbursement.
 
Medicaid pendency refers to the period during which an older adult seeking assistance in paying for care has applied for MA and their submitted application is under review. In our Commonwealth, MA pending applicants receive services and care immediately even though the provider does not yet receive any payment. Additionally, existing nursing home residents who had previously paid a private rate may also spend down to become Medicaid eligible and enter an MA pending period. Once approved, the care provider is paid retroactively. However, if the person is denied MA eligibility the facility has very little recourse to cover the cost of the person’s care. 
 
Frequent reports of delays in these applications being approved and/or renewed leave Long-Term Care providers in an unstable financial situation. Providers across the state have reported an increase to MA pending days and a lack of standardization in the application process. In some cases, applications are reported by providers to take over a year to process resulting in hundreds of thousands of dollars in uncompensated care providers must cover throughout the delay or absorb altogether if the application is ultimately denied.
 
I am introducing legislation that would establish reasonable timelines for the Department of Human Services (DHS) and the County Assistance Offices (CAO) to process these applications. If there are excessive delays, this bill would allow providers to get a portion of their reimbursement sooner and allow the provider to have the ability to request an individual’s application status while it is pending. If ultimately the individual is determined to not be eligible for MA, DHS could claw back interim reimbursement.
 
Please join me in sponsoring this legislation which supports Long-Term Care providers' mission caring for our state’s most vulnerable population, without forcing them to endure devastating financial risk.