Pennsylvania calls its Medicaid program Medical Assistance (MA), and in 2026 it covers millions of residents across several distinct eligibility categories. Whether you are an adult under 65, a pregnant person, a child, a senior, or someone who needs long-term care, the income limits differ significantly depending on which category applies to you. This guide breaks down every threshold, explains how the Federal Poverty Level (FPL) figures translate to monthly dollar amounts, and walks through the application process step by step.
What Is Pennsylvania Medical Assistance?
Medical Assistance is Pennsylvania's version of Medicaid, administered by the Department of Human Services (DHS). The program provides free or low-cost health coverage including doctor visits, hospital care, prescriptions, mental health services, and long-term care. Pennsylvania expanded Medicaid under the Affordable Care Act, which means most adults ages 19 to 64 with low incomes qualify, regardless of whether they have children or a disability.
Pennsylvania Medicaid Income Limits 2026
Income limits vary based on your age, household size, and the specific program category you are applying under. The tables below reflect 2026 figures.
Expansion Adults (Ages 19 to 64)
Adults in this category qualify at 138% of the Federal Poverty Level. There is no asset test for this group.
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|
| 1 | $1,836 | $22,032 |
| 2 | $2,489 | $29,868 |
| 3 | $3,137 | $37,644 |
| 4 | $3,785 | $45,420 |
| 5 | $4,433 | $53,196 |
| 6 | $5,081 | $60,972 |
For each additional person beyond six, add approximately $648 per month.
Pregnant Individuals
Pregnant people qualify at 220% FPL, which is one of the most generous thresholds in the state. Coverage begins as soon as you are pregnant and continues through 60 days postpartum.
| Household Size | Monthly Income Limit |
|---|
| 1 | $2,926 |
| 2 | $3,967 |
| 3 | $5,008 |
| 4 | $6,049 |
Children
Children under 19 have different income thresholds based on age group. Higher limits apply to younger children.
| Age Group | FPL Percentage | Monthly Limit (Household of 3) |
|---|
| Under 1 year | 220% FPL | $5,008 |
| Ages 1 to 5 | 162% FPL | $3,691 |
| Ages 6 to 18 | 138% FPL | $3,137 |
| CHIP (ages 6 to 18) | Up to 319% FPL | approximately $7,272 |
Children who exceed the Medicaid threshold but fall below 319% FPL may qualify for the Children's Health Insurance Program (CHIP), which provides similar benefits at little or no cost.
Aged, Blind, and Disabled (ABD) Medicaid
Seniors 65 and older and people with qualifying disabilities who are not in a nursing home fall under Regular Medicaid, also called ABD Medicaid. The income limit aligns with the SSI Federal Benefit Rate.
| Household Size | Monthly Income Limit |
|---|
| 1 (single) | $1,016 |
| 2 (couple) | $1,524 |
An asset test also applies to this group. Single applicants may have no more than $2,000 in countable assets, and couples may have up to $3,000.
Long-Term Care Medicaid (Nursing Home and Waiver)
This category covers individuals who need nursing home care or home and community-based waiver services through Pennsylvania's Community HealthChoices (CHC) program. The income limit is set at 300% of the Federal Benefit Rate.
| Applicant Status | Monthly Income Limit | Asset Limit |
|---|
| Single | $2,982 | $2,000 |
| Married, both applying | $5,964 total | $4,000 total |
| Married, one applying | $2,982 (applicant) | $2,000 (applicant), up to $162,660 (non-applicant spouse) |
The non-applicant spouse asset limit is the Community Spouse Resource Allowance (CSRA), designed to prevent the healthy spouse from being impoverished. The non-applicant spouse may also receive a Monthly Maintenance Needs Allowance of up to $2,644 from the applicant's income.
Important: nearly all of a nursing home resident's monthly income must go toward the cost of care, with only a $60 personal needs allowance retained.
Medically Needy Program (Spend-Down)
Pennsylvania also offers a Medically Needy Only (MNO-MA) pathway for people whose income exceeds regular Medicaid limits but who face high medical bills. You can qualify by "spending down" the difference between your income and the Medically Needy Income Limit (MNIL).
| Household Size | Monthly MNIL |
|---|
| 1 | $425 |
| 2 | $442 |
If your medical expenses in a six-month period reduce your income below the MNIL, you become eligible for that period. This pathway is most commonly used by seniors and people with disabilities.
What Counts as Income?
Pennsylvania counts most regular income sources when determining eligibility:
- Wages and self-employment earnings
- Social Security benefits (including SSDI and retirement)
- Pension and retirement account distributions
- Unemployment compensation
- Alimony
- Rental income
Income that is generally excluded includes child support received (for children's categories), certain irregular income, and income from needs-based programs like SSI and SNAP.
For expansion adults, Pennsylvania uses Modified Adjusted Gross Income (MAGI) methodology, which follows federal income tax rules rather than older asset-based tests.
Asset Limits by Program
Most Pennsylvania Medicaid categories for adults under 65 have no asset test. The exceptions are:
| Program | Single Asset Limit | Married Asset Limit |
|---|
| ABD Regular Medicaid | $2,000 | $3,000 |
| Nursing Home Medicaid | $2,000 | $4,000 |
| Community HealthChoices Waiver | $2,000 | $4,000 |
Pennsylvania law also allows an additional $6,000 exemption for ABD applicants who have a "burial fund" or similar set-aside, which can effectively raise the practical limit.
Assets that are typically exempt include your primary home (if you intend to return to it), one vehicle, household furnishings, personal belongings, and certain prepaid burial plans.
The 5-Year Look-Back Rule
For nursing home Medicaid, Pennsylvania reviews all asset transfers made within the five years before your application date. If you gave away assets or sold them below fair market value during that window, DHS may impose a penalty period during which Medicaid will not pay for care. This rule does not apply to expansion adults or most other non-long-term-care categories.
How to Apply for Pennsylvania Medical Assistance
Step 1: Gather Your Documents
Before you start the application, collect:
- Proof of identity (driver's license, state ID, passport, or birth certificate)
- Social Security numbers for all household members
- Proof of Pennsylvania residency (utility bill, lease, or bank statement)
- Proof of citizenship or immigration status
- Proof of income (pay stubs, tax returns, award letters for Social Security or SSI)
- Proof of assets if applying under ABD or long-term care categories (bank statements, investment account statements)
Step 2: Choose Your Application Method
Pennsylvania offers four ways to apply:
Online (fastest option): Visit COMPASS at compass.state.pa.us. Create a free account and complete the application. The portal walks you through each section and allows you to upload documents directly. Most online applications receive a decision faster than paper ones.
By phone: Call the Health Care Coverage Consumer Service Center at 1-866-550-4355. A representative can help you complete the application verbally.
In person: Visit your local County Assistance Office (CAO). You can find your local office at findmycao.pa.gov. Staff can assist with the application, explain what documents you need, and answer questions about eligibility.
By mail: Download a paper application from the DHS website, fill it out, and mail it to your local County Assistance Office. This method takes longer to process.
Step 3: Submit the Application
If applying online through COMPASS, submit directly through the portal. For paper applications, mail to the County Assistance Office that serves your county of residence. Keep a copy of everything you submit.
Step 4: Attend an Interview (If Required)
Some applicants, especially those applying for ABD or long-term care Medicaid, may be required to complete a phone or in-person interview with a DHS caseworker. The caseworker will verify your documents and ask clarifying questions about your situation.
Step 5: Receive Your Decision
DHS is required to process most Medicaid applications within 45 days. Applications based on disability have up to 90 days. You will receive a written notice explaining whether you were approved, denied, or if more information is needed.
You can track your application status at trackmybenefits.pa.gov.
Step 6: Enroll in a Managed Care Plan
Most Medical Assistance recipients in Pennsylvania are enrolled in a managed care organization (MCO), not traditional fee-for-service Medicaid. After approval, you will receive information about selecting a plan. If you do not choose one, you will be auto-enrolled. Major MCOs in Pennsylvania include UPMC for You, AmeriHealth Caritas, Keystone First, and Geisinger Health Plan, among others.
Renewals and Continuous Coverage
Once approved, your Medical Assistance coverage must be renewed annually. DHS will send you a renewal notice before your coverage end date. You can complete renewals online through COMPASS, by phone, or by returning a paper form. If your income or household size has changed since you enrolled, report it during renewal. In some cases, income changes could affect your eligibility category or cost sharing.
Pennsylvania Medicaid and CHIP Together
If your children's income exceeds Medicaid limits but falls below 319% FPL, CHIP is available as a companion program. CHIP covers children up to age 18 (or 19 if still in high school) with comprehensive benefits similar to Medicaid. CHIP has low or no premiums and minimal cost sharing. You apply through the same COMPASS portal.
Use the Benefits Screener
Not sure which program fits your situation? The free eligibility screener at BenefitsUSA checks your household against Medicaid, CHIP, SNAP, ACA subsidies, and other programs at once. It takes about three minutes and does not require you to create an account.
You can also visit the Pennsylvania benefits page for state-specific guides on SNAP, LIHEAP, and other assistance programs available in the state.
Frequently Asked Questions
Does Pennsylvania Medicaid cover dental and vision?
Adult Medical Assistance covers limited dental services, including emergency extractions and some preventive care. Vision coverage for adults is limited. Children enrolled in Medical Assistance or CHIP receive comprehensive dental and vision benefits through the HealthChoices program.
Can I have health insurance through work and still qualify for Medicaid?
Yes, in some cases. If your employer-sponsored insurance is considered unaffordable under ACA standards, or if your income falls below the Medicaid threshold, you may still qualify for Medical Assistance. Employer coverage does not automatically disqualify you.
What happens if I am undocumented?
Undocumented immigrants do not qualify for full Medicaid benefits in Pennsylvania. However, emergency Medicaid covers emergency medical conditions for income-eligible individuals regardless of immigration status. Pregnant undocumented immigrants may also qualify for limited prenatal care through state-funded programs.
Is there a waiting period before coverage starts?
For most applicants, coverage starts the first day of the month in which you apply if you are approved. For pregnant individuals, retroactive coverage may apply to the date pregnancy was established, and for some categories, coverage can be backdated up to three months before the application date if you were eligible during that period.
How do I appeal if I am denied?
You have 30 days from the date on your denial notice to request a fair hearing. You can request a hearing online through COMPASS, by phone, in writing, or in person at your County Assistance Office. The Pennsylvania Health Law Project (phlp.org) provides free legal help for Medicaid appeals.
What is the difference between Medicaid and CHIP in Pennsylvania?
Medicaid (Medical Assistance) covers children and adults who meet the income and eligibility requirements described in this guide. CHIP specifically covers children ages 0 to 18 whose family income is too high for Medicaid but still below 319% FPL. Both programs are free or very low cost, but they are administered and funded slightly differently.
Can seniors with higher incomes access Medicaid for nursing home costs?
Yes. Pennsylvania's spend-down program (Medically Needy) allows seniors whose income exceeds regular limits to qualify once medical expenses bring their net income below the MNIL. Additionally, the long-term care income limit of $2,982 per month is significantly higher than the regular ABD limit, so many seniors who do not qualify for regular Medicaid can still access nursing home coverage.
How do I find a Medicaid-accepting doctor in Pennsylvania?
You can search for providers through your managed care plan's online directory after enrollment. If you have not yet enrolled, COMPASS provides a provider search tool. You can also call the consumer helpline at 1-866-550-4355 for assistance finding a participating provider in your area.
