Pennsylvania Medicaid Income Limits 2026: Complete Eligibility Guide

Last Updated: February 2026

Pennsylvania Medicaid income limits for 2026 vary by household size and program type.

Single adults qualify with monthly income up to $1,732, while a family of four can earn up to $2,982 monthly for nursing home or waiver services.

Quick Summary:

• Single adults: $1,732/month income limit for standard Medicaid
• Families of four: Up to $2,982/month for long-term care services
• Asset limit: $2,000 for individuals ($8,000 with exemptions)
• Spousal protections available for married couples
• Income limits updated annually by Pennsylvania DHS
• No asset test for CHIP and some pregnancy coverage

What Are Pennsylvania Medicaid Income Limits?

Pennsylvania Medicaid income limits determine who qualifies for free or low-cost health coverage. The limits change based on your household size and the type of Medicaid program you need.

The Pennsylvania Department of Human Services (DHS) sets these limits each year. They follow federal poverty guidelines.

1. MAGI Medicaid (Expansion Adults, Parents, & Caregivers)

Eligibility is set at 138% of the FPL. This covers the “Expansion” population (non-elderly adults without disability).

Household Size	Annual Income Limit (138%)	Approx. Monthly Limit
1	$21,583	$1,799
2	$29,229	$2,436
3	$36,874	$3,073
4	$44,520	$3,710
5	$52,165	$4,347
Each Add’l	+ $7,645	+ $637

2. Pregnant Women & Infants (Under Age 1)

Eligibility is significantly higher to ensure prenatal care, set at 220% of the FPL.

Household Size	Annual Income Limit (220%)	Approx. Monthly Limit
1	$34,408	$2,867
2	$46,596	$3,883
3	$58,784	$4,899
4	$70,972	$5,914

3. Children’s Health Insurance Program (CHIP)

In PA, CHIP covers children in households earning up to 319% of the FPL.

• Family of 3: ~$105,200 annually.
• Family of 4: ~$127,000 annually.

4. Seniors & Disabled (Non-MAGI)

For those 65+ or with a disability, the income limit is strictly tied to the Federal Benefit Rate (FBR) or 100% FPL, depending on the specific sub-program.

• Individual: ~$12,193 annually ($1,016/mo).
• Couple: ~$18,291 annually ($1,524/mo).

Source: Pennsylvania Department of Human Services

These limits apply to Modified Adjusted Gross Income (MAGI) programs. This includes most adults, children, and pregnant women.

1. General Adults and Families (MAGI-Based) 

For most adults under 65, eligibility is determined by Modified Adjusted Gross Income (MAGI). 

• Adults (19–64): Up to 138% FPL, which is approximately $1,799 per month for a single person.
• Pregnant Women: Up to 220% FPL, roughly $2,596 per month.
• Children (0–18): Up to 319% FPL (including CHIP), approximately $4,147 per month. 

2. Seniors and Individuals with Disabilities (Non-MAGI)

Eligibility for those 65+ or with disabilities often includes an asset test in addition to income limits. 

• Regular Medical Assistance (ABD): The monthly income limit is $1,016.10 for an individual and $1,524.30 for a couple.
• SSI Recipients: Individuals receiving Supplemental Security Income (SSI) are typically automatically eligible for Medicaid. 

3. Long-Term Care & Home-Based Waivers 

For Nursing Home care or Community HealthChoices (Waiver) services:

• Gross Monthly Income Limit: $2,982 (300% of the Federal Benefit Rate).
• Resource Limits:
  • If income is at or below $2,982, the asset limit is $8,000.
  • If income is above $2,982, the asset limit drops to $2,400. 

4. Medical Assistance for Workers with Disabilities (MAWD)

MAWD allows individuals with disabilities who are working to have higher income: 

• Income Limit: Up to 250% FPL, which is $3,325 per month for a single person in 2026.
• Asset Limit: $10,000. 

Category	Monthly Income Limit (Single)	Asset Limit (Single)
Expansion Adults	~$1,799 (138% FPL)	None
Pregnant Women	~$2,596 (220% FPL)	None
Aged/Blind/Disabled	$1,016.10	$2,000
Long-Term Care/Waiver	$2,982	$2,400 – $8,000
MAWD (Working Disabled)	$3,325	$10,000

Understanding Pennsylvania Medicaid Eligibility 2026

Income limits are just one part of Pennsylvania Medicaid eligibility 2026. You must also meet other requirements.

Who Qualifies for Pennsylvania Medicaid?

Children and Teens:

• Age 18 and under
• Income up to 215% of federal poverty level
• No asset test required

Pregnant Women:

• Income up to 215% of federal poverty level
• Covers prenatal, delivery, and postpartum care
• No asset limit

Parents and Caretakers:

• Income up to 133% of federal poverty level
• Must have children under 19 living with them
• Asset limit of $2,000 applies

Adults Without Children:

• Age 19-64
• Income up to 138% of federal poverty level
• Must be U.S. citizen or legal resident

Seniors and People with Disabilities:

• Age 65+ or have qualifying disability
• Different income rules apply
• May qualify for long-term care services

Long-Term Care Income Limits

Long-term care Medicaid has different rules. This covers nursing home care and home-based waiver services.

2026 Long-Term Care Financial Limits

Single Applicants:

• Monthly income limit: $2,982
• Asset limit: $2,000 (or $8,000 with exemptions)
• Covers nursing home and waiver programs

Married Couples:

• Applicant income limit: $2,982/month
• Spouse can keep income up to $4,066.50/month
• Spouse asset protection: Up to $157,920

Pennsylvania offers spousal protections. The healthy spouse can keep more income and assets. This prevents financial hardship.

For complete details on qualifying, review Pennsylvania Medicaid income limits 2026 guidelines from DHS.

How Income Is Counted

Pennsylvania uses Modified Adjusted Gross Income (MAGI) for most Medicaid programs. Understanding what counts helps you know if you qualify.

What Counts as Income?

Counted Income:

• Wages and salaries
• Social Security benefits
• Unemployment compensation
• Pension and retirement income
• Self-employment earnings
• Rental income
• Interest and dividends

Not Counted:

• Child support received
• Veterans benefits (some programs)
• Supplemental Security Income (SSI)
• Certain Native American income
• Tax refunds

Income After Deductions

MAGI uses your adjusted gross income. This means income after certain tax deductions. It may be lower than your gross pay.

Asset Limits for Pennsylvania Medicaid

Some Medicaid programs have asset limits. Others don’t count assets at all.

2026 Asset Rules by Program

No Asset Test:

• Children’s Medicaid
• Pregnant women coverage
• Parent/caretaker coverage (MAGI-based)
• Medicaid expansion adults

$2,000 Asset Limit:

• Aged, Blind, and Disabled (ABD) programs
• Long-term care applicants
• SSI-related coverage

$8,000 Total Exemption:

• Pennsylvania allows $6,000 additional exemption
• Applies when income is below certain thresholds
• Helps working people with disabilities

What Assets Don’t Count?

Exempt Assets:

• Primary home (up to $713,000 equity)
• One vehicle
• Personal belongings and household items
• Life insurance with face value under $1,500
• Burial funds up to $1,500
• IRA or 401(k) if making withdrawals

Medicaid Fee Schedule 2026: What It Means for You

Understanding the Medicaid fee schedule 2026 helps you know what services are covered and how providers get paid.

Common Service Reimbursement Rates

Primary Care Visits:

• Short office visit (99213): $48.50 – $55.00
• Longer visit (99214): $70.00 – $82.00
• Preventive screenings for children: Higher rates to encourage care

Dental Services:

• Oral evaluation (D0120): ~$28.00
• Adult teeth cleaning (D1110): ~$52.00
• Adult dental: Emergency only in most cases

Mental Health Services:

• 45-minute therapy session (90834): $85.00 – $110.00
• Psychiatric evaluation (90791): $130.00 – $160.00
• Rates may vary by managed care plan

Important 2026 Coverage Changes

GLP-1 Drug Restrictions: Pennsylvania Medicaid stopped covering weight-loss drugs like Wegovy in 2026. Coverage continues only for diabetes or approved medical conditions.

Rural Health Clinic Rates: Providers in rural counties receive higher “all-inclusive” rates. Often exceeding $150 per visit to maintain access.

How to Apply for Pennsylvania Medicaid

Applying for Pennsylvania Medicaid is free. You can apply online, by phone, or in person.

Three Ways to Apply

1. Online (Fastest):

• Visit COMPASS
• Create an account
• Complete application in 30-45 minutes
• Upload documents electronically

2. By Phone:

• Call 1-866-550-4355
• Representatives available weekdays
• Assistance in multiple languages
• Accommodations for hearing impaired

3. In Person:

• Visit your County Assistance Office
• Bring required documents
• Get help completing forms
• Immediate answers to questions

Documents You’ll Need

Proof of Identity:

• Driver’s license or state ID
• Birth certificate
• Social Security card

Proof of Income:

• Recent pay stubs (last 30 days)
• Tax returns
• Social Security award letters
• Unemployment statements

Proof of Residency:

• Utility bill
• Lease or mortgage statement
• Mail with your current address

Medicaid Income Limits by State 2026

Pennsylvania’s income limits differ from other states. Each state sets its own Medicaid rules within federal guidelines.

How Pennsylvania Compares

Pennsylvania expanded Medicaid under the Affordable Care Act. This means more adults qualify compared to non-expansion states.

For comparison across all states, check Medicaid income limits by state 2026. You’ll see Pennsylvania offers more generous coverage than many Southern states.

Key Pennsylvania Advantages:

• Covers childless adults up to 138% poverty level
• No work requirements
• Retroactive coverage up to 3 months
• Comprehensive benefits including dental for children

Special Programs and Exemptions

Pennsylvania offers several special Medicaid programs beyond standard coverage.

CHIP (Children’s Health Insurance Program)

Income Limits:

• Children in families earning 215%-318% of poverty level
• Monthly premiums range from $0-$78
• Covers routine care, dental, and vision

Medicaid Waiver Programs

Available Waivers:

• OBRA waiver for people with disabilities
• Aged waiver for seniors
• Autism waiver
• COMMCARE waiver
• Person/Family Directed Support waiver

These programs allow people to receive care at home. Income limits may be higher than nursing home Medicaid.

Spend-Down Program

If your income exceeds limits, you may still qualify. The spend-down program works like a deductible.

How It Works:

• Calculate your excess income
• Pay medical bills equal to that amount
• Medicaid covers remaining costs
• Resets monthly

What to Do If You’re Denied

Don’t give up if your application is denied. You have the right to appeal.

Appeal Process Steps

1. Request Appeal (Within 30 Days):

• Call or write to County Assistance Office
• Explain why you disagree
• Request a fair hearing

2. Gather Evidence:

• Collect pay stubs and bank statements
• Get letters from doctors if disability-related
• Organize all paperwork

3. Attend Hearing:

• Present your case to an administrative law judge
• Bring witnesses if helpful
• Receive written decision

4. Further Appeals:

• Commonwealth Court if still denied
• Legal aid may help for free

Common Denial Reasons

Income Calculation Errors:

• Wrong household size used
• Incorrect income counted
• Deductions not applied

Missing Documentation:

• Incomplete application
• Documents not received
• Verification deadline missed

Eligibility Category Issues:

• Applied to wrong program
• Immigration status questions
• Residency not established

Keeping Your Coverage

Once approved, you must renew your Medicaid annually. Pennsylvania sends renewal forms by mail.

Annual Renewal Requirements

What to Do:

• Complete renewal form when received
• Report any changes within 10 days
• Update income and household information
• Respond to requests for verification

Automatic Renewals: Pennsylvania verifies eligibility using electronic data sources. If your information matches, renewal happens automatically.

Reporting Changes

You must report these changes within 10 days:

• New job or income increase
• Household size changes
• Address changes
• Pregnancy
• Gained other health insurance

Report changes through COMPASS or by calling your County Assistance Office.

Frequently Asked Questions

Official Resources

For the most current information, visit these official sources:

• Pennsylvania Department of Human Services – Official Medicaid program information
• COMPASS Application Portal – Apply or manage benefits online
• Centers for Medicare & Medicaid Services – Federal Medicaid guidance and state comparisons

Questions? Call the Pennsylvania Medicaid helpline at 1-866-550-4355 (Monday-Friday, 8:30 AM – 4:45 PM EST).