Pennsylvania Medicaid Income Limits (2026)

Pennsylvania Medicaid, formally called Medical Assistance (MA), is administered by the Pennsylvania Department of Human Services (DHS) and covers more than 3.1 million residents in 2026. Pennsylvania adopted the Affordable Care Act Medicaid expansion on January 1, 2015, extending coverage to adults ages 19 through 64 with household income at or below 138% of the Federal Poverty Level (FPL). The 2026 FPL baseline is $15,960 for a single person in the 48 contiguous states, with an increment of $5,680 per additional household member. At 138%, the 2026 Pennsylvania Medicaid income threshold is $22,025 per year for one person, rising to $45,540 for a family of four. These thresholds are sourced from the 2026 HHS Poverty Guidelines published by the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) at aspe.hhs.gov.

Pennsylvania Medicaid eligibility splits into several population groups with different income thresholds. Adults ages 19 through 64 qualify at 138% FPL through the ACA expansion. Pregnant women qualify at the more generous 220% FPL standard, and their Medical Assistance coverage continues for 12 full months after delivery regardless of income changes during that period. Children face age-graded thresholds: infants under age 1 and children ages 1 through 5 qualify at higher FPL levels than school-age children. For the aged, blind, or disabled population (age 65 and older or receiving Social Security Disability), Pennsylvania uses a separate Non-MAGI track with an asset test of $8,000 for a single applicant and $16,000 for a couple. Long-term care through a nursing home or the Community HealthChoices waiver carries its own income limit of $2,982 per month for an individual applicant in 2026. The federal Modified Adjusted Gross Income (MAGI) methodology applies to all non-ABD categories, meaning that assets are irrelevant and only income is counted for the majority of Pennsylvania Medicaid enrollees.

Pennsylvania residents apply for Medical Assistance through COMPASS (Commonwealth of Pennsylvania Access to Social Services), the state's integrated benefits portal at compass.dhs.pa.gov. A single COMPASS application captures Medical Assistance, CHIP, SNAP, LIHEAP, TANF, and other programs. Applications can also be submitted by phone at 1-866-550-4355 or in person at a County Assistance Office (CAO). Pennsylvania operates 68 county offices statewide, and applicants who need language assistance, help completing forms, or support navigating the system can request free assistance at any CAO. Standard applications are decided within 45 days; pregnancy applications are processed within 15 days under federal expedited rules; and presumptive eligibility determinations can provide temporary coverage within days while the full application is reviewed, as authorized under medicaid.gov federal rules.

Pennsylvania Medicaid (Medical Assistance) income limits by household size (2026)

Pennsylvania Medicaid income limits by household size (2026). Adult column = ACA expansion threshold (138% FPL) for adults ages 19-64. Children column = standard children's Medical Assistance (138% FPL for children ages 6-18; higher limits apply for younger children). Pregnancy column = Pennsylvania Medical Assistance for pregnant women (220% FPL). All figures based on 2026 HHS Federal Poverty Guidelines for the 48 contiguous states.

Pennsylvania Medicaid (Medical Assistance) eligibility requirements (non-income)

Pennsylvania Medicaid eligibility depends on income, residency, citizenship or immigration status, and the applicant's household composition. Most non-elderly non-disabled applicants are evaluated under the MAGI (Modified Adjusted Gross Income) methodology, which means there is no asset test for adults, parents, pregnant women, or children. The following non-income criteria apply across all Pennsylvania Medical Assistance categories.

• Pennsylvania residency: Applicants must live in Pennsylvania with the intent to remain. There is no minimum residency duration requirement. Individuals experiencing homelessness can apply at a County Assistance Office without a fixed address.
• Citizenship and immigration status: U.S. citizens and most lawful permanent residents who have been in the U.S. for at least 5 years qualify for full Medicaid. Certain qualified immigrants are exempt from the 5-year bar, including refugees, asylees, veterans, and active-duty military family members. Undocumented immigrants do not qualify for full Medicaid but may receive emergency Medicaid services and, if pregnant, prenatal care through Emergency Medical Assistance.
• Social Security Numbers: All household members applying for Medical Assistance must provide or apply for a Social Security Number, or provide proof that they have applied for one. Household members who are not applying for coverage are not required to provide a Social Security Number.
• Household composition: Pennsylvania Medicaid uses the federal household-composition rules under MAGI methodology. The household is generally defined as the tax-filing household, with specific rules for children, pregnant women, and married couples. Spouses living together are always counted together regardless of whether they file taxes jointly. A pregnant woman counts as herself plus the number of children she is expecting for income calculation purposes.
• Asset test for MAGI categories: No asset or resource test applies to adults, pregnant women, children, parents, or caretakers evaluated under MAGI. Pennsylvania does NOT require applicants in these groups to spend down savings, liquidate retirement accounts, or divest property before becoming eligible.
• Asset test for Non-MAGI (aged, blind, disabled): Individuals age 65 and older, people who are blind, or people with a qualifying disability are evaluated under Non-MAGI rules. The 2026 Pennsylvania asset limit is $8,000 for a single applicant and $16,000 for a couple. Excluded resources include the primary residence (when the applicant intends to return home or a spouse or dependent relative lives there), one vehicle, household goods, and life insurance with a face value under $1,500.
• Other health coverage: Pennsylvania Medicaid applicants are not disqualified for having Medicare or other health insurance. If an applicant has other insurance, Pennsylvania Medicaid may coordinate benefits and pay as the payer of last resort. Eligibility for employer-sponsored insurance may affect whether CHIP (rather than Medicaid) covers children in some households.

What income counts for Pennsylvania Medicaid (Medical Assistance)

Pennsylvania Medicaid uses the federal Modified Adjusted Gross Income (MAGI) standard to determine income for adults, pregnant women, children, parents, and caretaker relatives. MAGI-based income is essentially the same concept as adjusted gross income on a federal tax return, with a few specific additions. Pennsylvania applies the standard federal 5% MAGI disregard to the ACA expansion adult threshold, which effectively raises the income limit to approximately 143% FPL (the published 138% limit already incorporates this disregard for most programs). For Non-MAGI categories (aged, blind, disabled, and long-term care), Pennsylvania uses countable income rules that differ from MAGI and include various exclusions and deductions specific to those populations.

Income sources included

• Wages, salaries, tips, and other compensation from employment (W-2 income), including gross pay before taxes and deductions.
• Net self-employment income after business expenses (1099-NEC, Schedule C). Pennsylvania counts net self-employment earnings, not gross revenue.
• Social Security retirement and survivor benefits (the taxable portion, which is generally included in MAGI unless the individual has very low overall income).
• Social Security Disability Insurance (SSDI) benefits, to the extent they are taxable under federal rules.
• Pension, annuity, and retirement account distributions (including 401(k) and IRA withdrawals), whether from private or government pensions.
• Interest, dividends, capital gains (both short-term and long-term), and other investment income.
• Unemployment compensation, including both state and federal unemployment benefits.
• Rental income (net of allowable rental expenses), royalty income, and business income from partnerships or S corporations.
• Alimony received under divorce or separation agreements executed before January 1, 2019 (pre-TCJA agreements). Alimony from agreements executed after December 31, 2018, is excluded from MAGI under the Tax Cuts and Jobs Act.

Income sources excluded

• Supplemental Security Income (SSI) payments from the Social Security Administration. SSI is categorically excluded from MAGI income because it is a needs-based payment, not earned income.
• Child support payments received. Child support is explicitly excluded from MAGI calculations under federal Medicaid rules.
• Veterans' benefits, including VA disability compensation, the GI Bill education benefits, and veterans' pension payments.
• Workers' compensation payments, including both temporary disability and permanent disability awards.
• Cash assistance payments, including TANF (Temporary Assistance for Needy Families) grants.
• Gifts, inheritances, and proceeds from loans (including student loans). These are not income under MAGI rules.
• Foster care payments and adoption subsidy payments received for a foster child or adopted child living in the household.

How to apply for Pennsylvania Medicaid (Medical Assistance) in Pennsylvania

Pennsylvania Medical Assistance applications are submitted through COMPASS (Commonwealth of Pennsylvania Access to Social Services), the state's unified benefits portal operated by the Pennsylvania Department of Human Services. A single COMPASS application covers Medical Assistance, CHIP, SNAP, LIHEAP, TANF, and other state-administered programs, so applicants do not need to file separate applications for each benefit they may qualify for. Applications are accepted online at compass.dhs.pa.gov, by phone at 1-866-550-4355, by mail, or in person at any of Pennsylvania's 68 County Assistance Offices (CAOs). County offices also provide free in-person assistance, translation services, and disability accommodations for applicants who need support.

1. 1. Gather your documents before starting: government-issued photo ID, Social Security cards for all household members applying, proof of Pennsylvania residency (utility bill, lease, or mortgage statement), proof of income for all household members (pay stubs from the last 30 days, or a full year of records if self-employed), and proof of citizenship or immigration status (birth certificate, U.S. passport, or permanent resident card).
2. 2. Create a COMPASS account at compass.dhs.pa.gov (or call 1-866-550-4355 if you prefer to apply by phone). If you already have a COMPASS account from a previous application for SNAP or another program, log in using your existing credentials.
3. 3. Complete the Medical Assistance application. List every household member, report all sources and amounts of income, upload or describe your supporting documents, and answer all questions accurately. Do not leave income fields blank; write "$0" if a household member has no income in that category.
4. 4. Sign and submit the application electronically. COMPASS generates a confirmation number; save it and write it down in case you need to follow up with your County Assistance Office.
5. 5. Respond promptly to any DHS requests for additional information or verification documents. Pennsylvania DHS sends verification requests to the address on file; failure to respond within the specified window (typically 10 days) is one of the most common reasons applications are denied or delayed.
6. 6. Wait for the eligibility determination notice. Standard applications are decided within 45 days; pregnancy applications are decided within 15 days under federal expedited rules. After approval, your Medical Assistance card (or managed care enrollment packet) will arrive within 7 to 10 business days. If denied, the notice will explain the reason and your right to appeal within 30 days.

Official portal: compass.dhs.pa.gov

Documents needed

• Government-issued photo ID for the head of household (Pennsylvania driver's license, state ID, or U.S. passport).
• Social Security Numbers for every household member applying for Medical Assistance (or proof of application for a Social Security Number if one has not been assigned yet).
• Proof of Pennsylvania residency: a current utility bill, signed lease or rental agreement, or mortgage statement dated within the last 30 days showing a Pennsylvania address.
• Proof of U.S. citizenship or qualifying immigration status: U.S. birth certificate, U.S. passport, Certificate of Naturalization, Permanent Resident Card (Green Card), or Employment Authorization Document.
• Proof of income for the last 30 days: pay stubs from each employer in the household, or a letter from the employer stating hours worked and hourly wage. Self-employed applicants should provide the most recent federal tax return (Schedule C) or a written profit-and-loss statement for the most recent 12 months.
• Proof of pregnancy (if applying for pregnancy Medical Assistance): a signed statement or letter from a licensed health care provider confirming the pregnancy and expected due date.

Processing timeline: Standard Pennsylvania Medical Assistance applications are decided within 45 days of the date DHS receives the complete application. Pregnancy applications must be decided within 15 days under federal expedited processing rules. Disability-related applications that require a medical determination can take up to 60 to 90 days. Presumptive eligibility determinations, available at federally qualified health centers and qualifying hospitals, can provide temporary Medical Assistance coverage within one business day while the full application is reviewed.

Common reasons applications get denied

• Household income above the applicable threshold: the most common single denial reason. For adults, the 2026 limit is 138% FPL ($22,025 per year for one person; $45,540 for a family of four). Applicants who are over income for Medical Assistance may qualify for Pennsylvania CHIP (for children up to 319% FPL) or for ACA Marketplace subsidies through Pennie, Pennsylvania's state-based health insurance exchange.
• Failure to provide requested verification documents within the 10-day response window. DHS sends a verification request by mail; if the applicant does not respond or cannot be reached, the application is denied for failure to cooperate.
• Residency not established: the applicant could not provide documentation showing a Pennsylvania address, or the address provided could not be verified.
• Immigration status not qualifying: the applicant's immigration category is not one that makes them eligible for full Medicaid. Certain visa holders, parolees in some categories, and people with final removal orders may not qualify for full Medical Assistance.
• Application submitted but never completed or signed: COMPASS allows applicants to save a partial application, but only a fully signed and submitted application starts the eligibility clock. Incomplete applications that sit unsigned are eventually closed without a determination.

If your child's income is above the Pennsylvania Medicaid limit

Pennsylvania CHIP (Children's Health Insurance Program) covers children under age 19 in households that earn too much to qualify for Medical Assistance but still have moderate incomes. In 2026, Pennsylvania CHIP covers children in households with income up to 319% of the Federal Poverty Level, which is approximately $104,745 per year for a family of four. CHIP coverage in Pennsylvania is free or low-cost depending on household income, and it provides comprehensive benefits including doctor visits, dental, vision, mental health, prescription drugs, and hospital care. Children who are already enrolled in Medical Assistance but whose family income increases above the Medicaid limit are automatically evaluated for CHIP to ensure continuous coverage. Pennsylvania administers CHIP through the same DHS portal as Medical Assistance; families apply through compass.dhs.pa.gov or by calling 1-800-986-KIDS (1-800-986-5437).

Compare Medicaid and CHIP income limits for all 50 states

If you are 65 or older with limited income: Pennsylvania Medicare Savings Programs

Pennsylvania administers three Medicare Savings Programs (MSPs) for low-income residents who are enrolled in Medicare. These programs help pay Medicare Part A and Part B premiums, deductibles, and cost-sharing. In 2026, the Qualified Medicare Beneficiary (QMB) program covers those with monthly income at or below $1,350 for a single person or $1,824 for a couple; QMB pays Part A and Part B premiums plus cost-sharing. The Specified Low-Income Medicare Beneficiary (SLMB) program covers those with income up to $1,616 per month (single) or $2,184 (couple); SLMB pays the Part B premium only. The Qualifying Individual (QI) program covers those with income up to $1,816 per month (single) or $2,455 (couple) and also pays the Part B premium. Enrollment in any MSP automatically qualifies the individual for Extra Help with Medicare Part D prescription drug costs. Pennsylvania residents apply for all three MSPs through the same COMPASS portal at compass.dhs.pa.gov or by calling 1-866-550-4355. An estimated 12 million Americans are dually eligible for Medicare and Medicaid nationally; Pennsylvania has one of the largest dual-eligible populations in the Mid-Atlantic region.

Read the full Medicare eligibility guide

Frequently Asked Questions