To qualify for Medicaid in PA — the state’s Medical Assistance program — you need to fit one of the covered groups and have household income within that group’s limit. The groups are children, pregnant women, parents and caretakers, adults aged 19 to 64, seniors 65 and older, and people with disabilities. For most non-disabled adults, the income ceiling is 133% of the Federal Poverty Level, which works out to roughly $22,025 per year for a single person in 2026 after the standard 5% income disregard.1ASPE. 2026 Poverty Guidelines: 48 Contiguous States Children, pregnant women, and workers with disabilities qualify at higher income levels, and seniors and people with disabilities face an added asset test.
Covered Groups and Their Income Limits
Pennsylvania Medical Assistance is organized around categories of people, and each category has its own financial rules.2Cornell Law School. Pennsylvania Code 55 Pa. Code 141.21 – Policy For most applicants, income is measured using Modified Adjusted Gross Income (MAGI), which is based on your federal tax return — wages, Social Security, interest, and other earnings — with a few adjustments such as treating lump-sum payments as income only in the month received.3eCFR. 42 CFR 435.603 – Application of Modified Adjusted Gross Income (MAGI)
Adults Aged 19 to 64
Non-disabled adults qualify under Pennsylvania’s Medicaid expansion if household income is at or below 133% of FPL. A standard 5% disregard effectively raises the threshold to about 138%. Based on 2026 federal poverty guidelines, the approximate annual income limits are:4Medicaid.gov. Medicaid, Childrens Health Insurance Program, and Basic Health Program Eligibility Levels
- Single person: about $22,025
- Family of two: about $29,863
- Family of three: about $37,702
- Family of four: about $45,540
You do not need to have children or a disability. Parents and caretakers responsible for a child under 18 fall into this same income bracket.
Pregnant Women and Children
Children and pregnant women qualify at higher income levels, with the most generous cutoffs reserved for infants and expectant mothers. The following limits took effect January 13, 2026:5Commonwealth of Pennsylvania Department of Human Services. Federal Poverty Income Guidelines
- Pregnant women and infants under age 1: household income at or below 215% of FPL. For a family of four, about $5,913 per month.
- Children ages 1 through 5: at or below 157% of FPL. For a family of four, about $4,318 per month.
- Children ages 6 through 18: at or below 133% of FPL. For a family of four, about $3,658 per month.6Pennsylvania Department of Human Services. Medical Assistance Eligibility Handbook – 312.1 General Policy
Once a pregnant woman is approved, her coverage continues through the end of the twelfth month after delivery, regardless of any income changes during that period.6Pennsylvania Department of Human Services. Medical Assistance Eligibility Handbook – 312.1 General Policy Presumptive eligibility can also provide temporary prenatal coverage for outpatient services while the full application is being processed.7Pennsylvania Code and Bulletin. Pennsylvania Code 55 Pa. Code 140.141 – Presumptive Eligibility
Seniors and People with Disabilities
Adults 65 and older and people with a documented disability qualify based on both income and resources. Unlike MAGI-based groups, this category also has to pass an asset test, covered below.
Asset Limits
Most people who qualify under MAGI — children, pregnant women, parents, and non-disabled adults in the expansion group — face no asset or resource test. The state looks only at income.
Seniors 65 and older and people with disabilities are the exception. Countable assets cannot exceed $2,000 for an individual or $3,000 for a couple, and those limits remained unchanged for 2026.8Social Security Administration. 2026 Cost-of-Living Adjustment (COLA) Fact Sheet9Cornell Law School. Pennsylvania Code 55 Pa. Code 178.1 – General Policy on MA Resources Common to All Categories of MA Several things you own are not counted:
- Your home, as long as equity does not exceed $752,000 under the 2026 long-term care threshold.10Pennsylvania Department of Human Services. Appendix A – Determining Medical Assistance Eligibility and Payment Toward the Cost of LTC Facility Services
- One vehicle, typically excluded if used for transportation to medical appointments or work.
- Burial plots, designated burial funds, and life insurance policies with limited face values.
Residency and Citizenship
Every applicant has to be a Pennsylvania resident. You need to show you actually live in the Commonwealth, but no minimum length of residence is required before applying.11Cornell Law School. Pennsylvania Code 55 Pa. Code 141.1 – Policy You also have to be a U.S. citizen or a qualified non-citizen.
Non-citizens face a federal “five-year bar.” If you entered the United States on or after August 22, 1996, and later obtained qualified non-citizen status, you generally cannot receive federally funded Medical Assistance for five years from the date you received that status.12Pennsylvania Department of Human Services. Medical Assistance Eligibility Handbook – 322.3 Non-Citizen Status Refugees, asylees, and several other categories are exempt. Non-citizens who entered before August 22, 1996, and remained continuously present are also not subject to the waiting period.
If Your Income Is Slightly Too High
Three paths exist for people who miss the standard income cutoffs.
Medically Needy Spend-Down
If your income is just over the limit, you may still qualify through the Medically Needy Program by spending down your excess income on medical expenses.13Pennsylvania Department of Human Services. Medical Assistance Eligibility Handbook – NMP Spend-Down The County Assistance Office first subtracts $10 from your net income. If the remainder still exceeds the Medically Needy limit, you can apply paid or unpaid medical expenses — hospital bills, prescription costs, doctor visit charges — to reduce it further. Only expenses paid in the current month or unpaid bills from the retroactive eligibility period count. If your income drops to or below the limit after these deductions, you qualify for that month’s coverage.
Medical Assistance for Workers with Disabilities (MAWD)
Working people with a disability who earn too much for standard Medicaid can qualify through MAWD, which raises the income ceiling to 250% of FPL — roughly $39,900 per year for a single person in 2026.14Pennsylvania Department of Human Services. MAWD Income and Resource Limits – Appendix A MAWD also raises the resource limit to $10,000 regardless of family size. You must be working, and your earnings cannot exceed the Social Security Substantial Gainful Activity threshold: $1,690 per month for non-blind individuals or $2,830 per month for blind individuals in 2026.
CHIP for Children
Children whose family income is above the Medicaid cutoff may still qualify for the Children’s Health Insurance Program. CHIP’s lower income threshold matches the upper Medicaid limit for each age group, and coverage tiers extend up to 314% of FPL:15Commonwealth of Pennsylvania. 2026 Federal Income Guidelines for Determining CHIP Eligibility
- Free coverage up to about 208% of FPL.
- Subsidized coverage, with premiums rising by income band, between about 208% and 288% of FPL.
- Full-cost coverage between about 288% and 314% of FPL.
When you apply for either program, the state evaluates eligibility for both. Medicaid takes priority if the child’s income qualifies.
Long-Term Care Has Extra Rules
If you are applying for Medicaid to pay for nursing facility care or home and community-based services, standard eligibility is not the whole picture. Two additional rules apply.
The first is a five-year look-back. The County Assistance Office reviews any assets you transferred, sold, or gave away within the 60 months before you entered a long-term care facility or were assessed as eligible for home and community-based services and applied for Medicaid.16Commonwealth of Pennsylvania. MA and Payment of Long-Term Care Transferring an asset for less than fair market value triggers a penalty period during which the state will not pay for your care, calculated by dividing the uncompensated value by the average daily cost of private-pay long-term care.
The second is estate recovery. Pennsylvania can seek reimbursement from a deceased recipient’s estate for long-term care Medicaid payments made from age 55 onward.17Department of Human Services. Estate Recovery Collection is postponed in several situations: until the death of a surviving spouse, until a surviving child turns 21, or until the death of a surviving child who is blind or has a permanent disability.18Cornell Law School. Pennsylvania Code 55 Pa. Code 258.7 – Postponement of Collection The Department may also waive its claim under hardship provisions, such as when the estate is valued at $2,400 or less and there is an heir, or when a family member depends on an estate asset as their primary income source and the household would fall below 250% of FPL without it.19Cornell Law School. Pennsylvania Code 55 Pa. Code 258.10 – Undue Hardship Waivers
How to Apply
The fastest way to apply is through the COMPASS online portal at compass.dhs.pa.gov.20COMPASS. COMPASS Homepage You can also submit a paper application — Form PA 600 for standard coverage or Form PA 600 L for long-term care — by mail or in person at your local County Assistance Office.
Before applying, gather:
- A government-issued ID and Social Security numbers for every household member seeking coverage.
- Proof of residency, such as a utility bill, lease, or mortgage statement with a Pennsylvania address.
- Income verification: recent pay stubs, W-2 forms, or tax returns. Report gross monthly income, before taxes or deductions.
- Names and addresses of current employers, plus details on any other income sources such as unemployment benefits or child support.
List everyone in the household who shares income and expenses. Incomplete or inconsistent information slows down the review.