Pennsylvania Medicaid Eligibility 2026

Pennsylvania offers Medicaid (called Medical Assistance) to low-income residents. Income and asset limits vary by program type.

This guide explains who qualifies in 2026 and how to apply.

Quick Summary:

• Long-term care income limit: $2,982/month for singles
• Regular Medicaid (ABD): $989.10/month for seniors and disabled
• Asset limits: $8,000 (or $2,400 depending on income)
• Expansion adults: Up to 138% of Federal Poverty Level
• 5-year look-back applies to asset transfers
• Apply online at COMPASS or call 1-866-550-4355

Last Updated: January 2026

Pennsylvania Medicaid Income Limits 2026

Income limits depend on which Medicaid program you need.

Long-Term Care Medicaid

This covers nursing homes and home-based care services.

Monthly income limits:

• Single person: $2,982
• Married couple (both applying): $5,964
• Married (one applying): $2,982

This increased from $2,901 in 2025.

Regular Medicaid for Seniors and Disabled (ABD)

For people 65+, blind, or disabled living at home.

Monthly income limits:

• Single: $989.10
• Married (both applying): $1,582.05
• Married (one applying): $1,582.05

MAGI Medicaid Programs

For children, pregnant women, parents, and adults age 19-64.

Income limits by Federal Poverty Level (FPL):

Group	Income Limit
Children 0-1	220% FPL
Children 1-5	162% FPL
Children 6-18	138% FPL
Pregnant women	138% FPL
Parents with kids under 21	138% FPL
Adults 19-64	138% FPL
CHIP (children)	319% FPL

Example: For a single adult, 138% FPL equals about $20,783 per year.

Pennsylvania Medicaid Asset Limits 2026

Asset limits depend on your monthly income.

Standard Asset Limits

If your monthly income is $2,982 or less:

• Asset limit: $8,000

If your monthly income exceeds $2,982:

• Asset limit: $2,400

Pennsylvania adds a $6,000 asset exemption for most applicants.

Assets That Don’t Count (Exempt)

These assets are not counted toward your limit:

• Your primary home (with limits)
• One vehicle
• Household furniture and belongings
• Clothing and jewelry
• Medical equipment
• Prepaid burial funds (irrevocable)

Home Equity Rules

Your home is exempt if:

• Your spouse lives there, OR
• Your child under 21 lives there, OR
• Your disabled child (any age) lives there, OR
• Home equity is below $752,000

If equity exceeds $752,000, the excess counts as an asset.

Married Couple Special Rules

When one spouse needs Medicaid, the other spouse gets protections.

Community Spouse Resource Allowance (2026)

The healthy spouse can keep:

• Maximum: $162,660 in assets
• Minimum: $32,532 in assets

Community Spouse Income Allowance

The healthy spouse can keep:

• Minimum: $2,644/month
• Maximum: $4,066.50/month (if housing costs are high)

Income can shift from the applicant to the healthy spouse.

Medicaid Look-Back Period

Pennsylvania reviews asset transfers from the past 5 years (60 months).

Transfer Penalty Calculation

If you gave away assets, Medicaid calculates a penalty.

2026 penalty divisor: $421.20 per day (or $12,811.50/month)

Formula: Gift amount ÷ Penalty divisor = Days of ineligibility

Example: A $40,000 gift = 95 days without Medicaid coverage.

Transfers That Don’t Cause Penalties

You can spend money on:

• Nursing home bills
• Medical expenses
• Property taxes and utilities
• Legal fees for Medicaid planning
• Exempt assets (burial funds, home repairs)

Types of Pennsylvania Medicaid Programs

1. Long-Term Care Programs

Nursing Home Medicaid

• Covers room, board, nursing care, and medications
• Must meet income and asset limits

Home & Community-Based Services (HCBS)

• Personal care at home
• Adult day care
• Home modifications
• Respite care for caregivers

Community HealthChoices (CHC)

• Managed care for seniors with Medicare and Medicaid
• Coordinates all health services

LIFE Program

• For seniors 55+
• Includes dental, vision, and day center services

2. Regular Medicaid (ABD)

For seniors 65+, blind, or disabled people.

Covers doctor visits, hospital care, and prescriptions.

3. MAGI Programs

For families, children, pregnant women, and working-age adults.

Based on household income and size.

4. Special Programs

• Medical Assistance for Workers with Disabilities (MAWD)
• Breast and Cervical Cancer Treatment
• Medicare Buy-In Programs

Spend-Down Option

If your income is too high, you can “spend down” to qualify.

Medically Needy Income Limit (2026)

• Single: $425/month
• Couple: $442/month

How it works: Subtract medical bills from your income over 6 months. If you reach the limit, you qualify.

Asset limits for spend-down: $2,400 (single), $3,200 (couple)

What Income Counts?

Income That Counts

• Wages and salary
• Social Security benefits
• Pensions and retirement withdrawals
• Interest and dividends
• Veterans benefits (some)
• Alimony

Income That Doesn’t Count

• SSI (Supplemental Security Income)
• SNAP (food stamps)
• TANF (cash assistance)
• LIHEAP (heating help)
• VA Aid & Attendance benefits

What Does Pennsylvania Medicaid Cover?

Medical Services

• Doctor visits and preventive care
• Hospital stays
• Prescription medications
• Nursing home care
• Physical therapy and rehabilitation
• Lab tests and X-rays
• Emergency transportation
• Dental care (limited)
• Vision care (limited)

Mental Health Services

• Counseling and therapy
• Psychiatric hospital care
• Drug and alcohol treatment
• Crisis support

Children’s Services (EPSDT)

Children under 21 get comprehensive care:

• Annual checkups
• Hearing and vision tests
• Dental care
• Developmental screenings
• Behavioral health services

2026 Medication Change

Important: GLP-1 drugs (Wegovy, Zepbound) are no longer covered for weight loss only. They’re still covered for diabetes treatment.

Who Qualifies for Pennsylvania Medicaid?

Basic Requirements

You must:

• Live in Pennsylvania
• Be a U.S. citizen or qualified immigrant
• Have a Social Security Number
• Meet income and asset limits

Medical Requirements

For long-term care programs: You must need nursing home level care.

For regular ABD: You must be 65+, blind, or disabled.

How to Apply for Pennsylvania Medicaid

Application Options

1. Online (Fastest)

• Visit COMPASS.state.pa.us
• Create an account
• Complete the application

2. By Phone

• Call 1-866-550-4355
• Monday–Friday, 8:30 AM–5 PM

3. In Person

• Visit your local County Assistance Office
• Find locations at pa.gov

4. By Mail

• Download application from pa.gov
• Mail to your County Assistance Office

Documents You’ll Need

Gather these before applying:

• Driver’s license or state ID
• Social Security card
• Proof of income (pay stubs, bank statements)
• Proof of assets (bank accounts, property deeds)
• Birth certificate or passport
• Current health insurance cards

Key Changes for 2026

Income Limit Increase

Long-term care income limit rose from $2,901 to $2,982 per month.

Penalty Divisor Update

Transfer penalty divisor increased to $421.20/day.

This reflects higher nursing home costs.

Medication Coverage Change

GLP-1 weight loss drugs no longer covered for obesity treatment alone.

Asset Protections

The $6,000 asset exemption remains in place for 2026.

Frequently Asked Questions (FAQs)

Apply Today

Pennsylvania Medicaid helps thousands of residents get health coverage. Don’t wait to apply if you need help.

Start your application now:

• Visit compass.state.pa.us
• Call 1-866-550-4355

For questions about eligibility, contact your local County Assistance Office.

Official Sources

All information based on Pennsylvania Department of Human Services guidelines and official Medicaid policy:

• Pennsylvania DHS: pa.gov/agencies/dhs
• COMPASS Application Portal: compass.state.pa.us
• Centers for Medicare & Medicaid Services: medicaid.gov