PA Medical Assistance Income Limits and Eligibility

Pennsylvania Medical Assistance income limits in 2026 depend on which category of coverage you’re applying for. For most adults ages 19 to 64, the effective monthly cutoff is about $1,836 for a single-person household (138% of the Federal Poverty Level). Pregnant women, young children, workers with disabilities, and people who need nursing home or in-home long-term care each have their own thresholds, and several are significantly more generous.

2026 Income Limits by Category

Adults Ages 19 to 64

Non-disabled adults qualify if household income is at or below 133% of the Federal Poverty Income Guidelines, with a 5% income disregard that effectively raises the cutoff to about 138% of the FPL.¹ Based on the 2026 Federal Poverty Guidelines, the approximate monthly limits are:²

1 person: about $1,836 per month
2 people: about $2,489 per month
3 people: about $3,142 per month
4 people: about $3,796 per month

Each additional household member raises the limit by roughly $654 per month. These figures come from the 2026 FPL ($15,960 per year for a single individual) multiplied by 138% and divided by twelve. Pennsylvania publishes exact monthly dollar amounts each year, so the state’s official table may differ by a few dollars.

Pregnant Women and Children

Children and pregnant women get higher thresholds. All figures below include the 5% disregard:

Pregnant women and infants under age 1: up to 220% of the FPL, or about $2,927 per month for a single-person household. When determining household size, each unborn child counts as a household member.³
Children ages 1 to 5: up to 162% of the FPL.⁴
Children ages 6 to 18: up to 138% of the FPL, the same as non-disabled adults.⁴

Children with severe disabilities can also qualify through a separate category called PH-95, in which parental income is disregarded and only the child’s own income is measured against 100% of the FPL for one person. Less than half of a child’s earned income is countable, and court-ordered child support and Social Security disability payments the child receives are excluded entirely.⁵ PH-95 is a category of last resort, so the County Assistance Office will first check whether the child qualifies under a standard category using the family’s income.⁶

Workers with Disabilities (MAWD)

Medical Assistance for Workers with Disabilities is for Pennsylvanians ages 16 to 64 who have a disability and are currently working and paid. The income limit is 250% of the FPL, which in 2026 works out to:⁷

Single applicant: $3,325 per month
Married couple: $4,509 per month

MAWD household size only counts the applicant, or the applicant and spouse. Children are not factored in. The applicant must meet Social Security’s or Pennsylvania’s disability standard. MAWD also has a $10,000 resource limit for both single and married applicants.⁸

Long-Term Care Medicaid

Long-term care Medicaid covers nursing home care and Home and Community-Based Services (HCBS) waiver programs that support people in their own homes. Income is calculated differently from standard Medical Assistance and does not use Modified Adjusted Gross Income.

For HCBS waiver programs like Community HealthChoices, the 2026 monthly income limit for a single applicant is $2,982 in gross income, and only the applicant’s own income counts. For nursing home Medicaid, income is generally less of a barrier because the monthly cost of care almost always exceeds the applicant’s income. The applicant’s income is paid to the facility and Medicaid covers the rest.

When one spouse enters a nursing home or gets HCBS waiver services and the other stays in the community, spousal impoverishment rules protect the community spouse. The community spouse can keep a share of the couple’s combined resources called the Community Spouse Resource Allowance, which can be as high as $162,660 in 2026. The community spouse also keeps their own income, and if it falls below a minimum monthly maintenance needs allowance, a portion of the institutionalized spouse’s income can be redirected before any payment to the facility.

Over the Limit? The Spend-Down Option

Pennsylvania offers a “medically needy” spend-down pathway for people whose income exceeds the standard limits but who have high medical expenses. You subtract incurred medical costs from your countable income. If the remainder drops to or below Pennsylvania’s medically needy income level, you become eligible for Medical Assistance for the rest of the budget period.

Countable expenses include health insurance premiums, Medicare cost-sharing, copayments, deductibles, and bills for services Medicaid would cover. Pennsylvania measures income and medical expenses over a budget period that runs from one to six months. Eligibility returns once accumulated medical expenses close the gap between your income and the medically needy threshold. This route is most useful for older adults and people with disabilities who have regular ongoing medical bills.

How Pennsylvania Counts Income and Household Size

Countable Income

For MAGI-based programs, which cover most children, pregnant women, and non-disabled adults, Pennsylvania generally follows federal tax rules. Countable income is your adjusted gross income from your tax return plus certain tax-exempt income like non-taxable Social Security benefits and tax-exempt interest.

For non-MAGI programs like MAWD and long-term care Medicaid, the state counts both earned income (wages, self-employment) and unearned income (Social Security, pensions, veterans’ benefits, unemployment, dividends, interest).⁹ Supplemental Security Income, SNAP, and TANF payments do not count. The aid-and-attendance portion of veterans’ benefits is also excluded.

Household Size

MAGI-based programs use federal tax filing rules to determine household size. Your MAGI household includes the tax filer, the filer’s spouse if they live together, and all claimed tax dependents.¹⁰ For non-MAGI programs like MAWD, the household is just the applicant, or the applicant and spouse.

Do Assets Also Count?

MAGI-based programs, covering most children, pregnant women, and adults under 65, have no asset test. Eligibility is based solely on income and household size. Asset limits only apply to non-MAGI programs: Medical Assistance for people 65 and older, people with disabilities, MAWD, and long-term care Medicaid.¹

For long-term care Medicaid, a single applicant faces a $2,000 asset limit. HCBS waiver applicants whose gross monthly income is at or below the special income level get an increased resource limit of $8,000. MAWD has a flat $10,000 resource limit for both single and married applicants.⁸

Not everything counts. Pennsylvania exempts your primary home (subject to an annually adjusted equity interest limit), one vehicle, household goods, personal belongings, and burial reserves within specified limits.¹ Countable assets include bank accounts, certificates of deposit, stocks, bonds, some trust funds, life insurance cash value, and property beyond your primary residence.

Long-term care applicants face an additional wrinkle: the 60-month look-back. Pennsylvania reviews all asset transfers you or your spouse made during the five years before applying, and any gift or below-market sale can trigger a penalty period during which Medicaid will not pay for long-term care. The penalty is calculated by dividing the value of improperly transferred assets by the average monthly cost of nursing home care in Pennsylvania, with no cap on length. The federal gift tax exemption ($19,000 per recipient per year in 2026) is irrelevant here; Medicaid treats the gift as a disqualifying transfer regardless.

How to Apply

You can apply through any of these channels:¹¹

Online through the COMPASS website at compass.state.pa.us
In person at your local County Assistance Office
By mail, using a paper application from pa.gov sent to your County Assistance Office
By phone, if you need help completing the application

Before you start, gather proof of income for all household members, Social Security numbers and birth dates, proof of identity and Pennsylvania residency, and details about any current health insurance. For programs with asset limits (MAWD, long-term care, and coverage for people 65 and older), also bring bank statements, investment account records, vehicle information, and documentation of any property you own.⁸

Pennsylvania’s internal policy requires the County Assistance Office to decide on your application within 30 calendar days.¹² Federal regulations set a ceiling of 45 days for non-disability-based applications and 90 days for applications based on a disability.¹³ If you had unpaid medical bills in the three months before you applied, mention them; federal law allows Medicaid to cover services from that period if you would have qualified at the time. Once approved, most recipients are enrolled in HealthChoices, the state’s mandatory managed care program, where you choose a plan and primary care provider from the options available in your area.

1
Commonwealth of Pennsylvania. Medicaid / Medical Assistance General Eligibility Requirements
2
HHS ASPE. 2026 Poverty Guidelines: 48 Contiguous States
3
Commonwealth of Pennsylvania. Medicaid/Medical Assistance for Children and Pregnant Women: Pregnancy and Family Planning
4
Medicaid.gov. Medicaid, Children’s Health Insurance Program, and Basic Health Program Eligibility Levels
5
Commonwealth of Pennsylvania. PH-95 Brochure
6
Department of Public Welfare. 315.5 Determining Eligibility
7
Department of Public Welfare. Appendix A: MAWD Income and Resource Limits
8
Commonwealth of Pennsylvania. Apply for Medical Assistance for Workers with Disabilities (MAWD)
9
PA DPW Policy Manuals. Income Limits for Medical Assistance in PA
10
Medical Assistance Eligibility Handbook. 312.2 Who Is in the MAGI Household?
11
Commonwealth of Pennsylvania. Apply for Medicaid Benefits
12
Department of Public Welfare. 104.5 Processing an Application
13
eCFR. 42 CFR 435.912 – Timely Determination and Redetermination of Eligibility