Pennsylvania Medicaid 2026: Income Limits, Medical Assistance & How to Apply

Quick answer: Pennsylvania expanded Medicaid — known in PA as Medical Assistance (MA) — so most adults ages 19–64 qualify with income up to 138% of the Federal Poverty Level — about $1,836 per month for one person ($22,025 per year) or roughly $45,540 per year for a family of four — with no asset test for working-age adults. It’s run by the Department of Human Services (DHS), and you apply through COMPASS at compass.state.pa.us.

Who This Is For

This guide is for Pennsylvanians trying to understand whether they or a family member can get health coverage through Medical Assistance (Pennsylvania’s name for Medicaid) in 2026. Medical Assistance covers approximately 3 to 3.5 million Pennsylvania residents — a substantial share of the state’s population — and includes not just children and seniors but also a large number of working-age adults who qualify through the state’s Medicaid expansion.

Pennsylvania expanded Medicaid in January 2015 under the ACA, which means that low-income adults of any household composition — including single adults and couples without children — can qualify based on income alone. You do not need to have a disability, be pregnant, or have dependent children to be eligible if your income falls within the threshold. This makes Pennsylvania’s Medical Assistance significantly more accessible than programs in non-expansion states, where those categories are often the only pathways to coverage.

This guide explains the income limits for each group, how to apply through COMPASS, Pennsylvania’s distinctive long-term care programs, and the changes coming in late 2026 that enrolled members should prepare for now. For a state-by-state comparison, see our guide on Medicaid income limits by state. For a national overview, see our Medicaid overview.

Pennsylvania Expanded Medicaid — Adults 19–64

Since January 2015, all legally present adults under 65 — whether or not they have children — qualify for Medical Assistance if their income is at or below 138% of the Federal Poverty Level. For a single adult in 2026, that threshold is approximately $1,836 per month ($22,025 per year). For a family of four, the annual limit is approximately $45,540.

More than 1.1 million Pennsylvanians are currently covered through the expansion group. These are adults who would not have been eligible for any Medicaid coverage before expansion — people working low-wage jobs, gig workers, people between jobs, and adults whose employers don’t offer affordable coverage. The expansion eliminated the requirement that an adult must belong to a specific demographic category (parent, disabled, elderly) to access coverage through Medicaid.

There is no asset test for working-age adults, children, and pregnant women under MAGI rules. You do not need to spend down savings, sell a car, or liquidate any assets to qualify. Eligibility is determined solely by your current monthly income using Modified Adjusted Gross Income accounting. Having a job does not disqualify you — the program is designed precisely to cover low-wage workers who don’t have employer-sponsored insurance. An adult earning $1,700 per month at a part-time or full-time job qualifies; one earning $2,000 per month does not, under current 2026 thresholds.

Pennsylvania Medical Assistance benefits for expansion adults are comprehensive, delivered through Medicaid managed care (HealthChoices) plans: primary care, specialist visits, hospital services, prescription drugs, mental health and substance use treatment, dental care, vision, and preventive services. After enrollment, you’ll be assigned to or choose from the managed care plans available in your county.

Income Limits by Group (2026)

Pennsylvania’s Medical Assistance income thresholds vary by population. The figures below are gross monthly or annual income based on MAGI rules. The 2026 Federal Poverty Level for one person is approximately $1,330 per month ($15,960 per year):

• Adults 19–64 (Medicaid expansion): Up to 138% FPL — approximately $1,836 per month for a single adult, or approximately $45,540 per year for a family of four. No asset test. No spend-down for this group.
• Children (ages 0–17): Up to approximately 215–220% FPL through Medical Assistance. No asset test. Children can qualify even if their parents earn too much for adult Medicaid.
• CHIP (Children’s Health Insurance Program): Pennsylvania’s CHIP covers children up to 319% FPL — one of the highest CHIP income ceilings in the country. CHIP is free for children in families below approximately 235% FPL; modest premiums begin above that level. Families whose children earn too much for Medical Assistance but still can’t afford private insurance should apply for CHIP.
• Pregnant women: Up to approximately 215–220% FPL, with 12 months of full postpartum coverage following the birth. Presumptive eligibility is available for pregnant women — qualifying healthcare providers can grant temporary coverage so that prenatal care can begin immediately while the full application is processed.
• Parents and caretaker relatives: Qualify through the expansion at 138% FPL — the same threshold as other adults. Apply under whichever pathway gives you the higher income limit; in practice, most low-income parents in Pennsylvania qualify under the expansion group.
• Aged, Blind and Disabled (ABD): Subject to an asset test ($2,000 limit for a single individual). The Medically Needy program provides a spend-down pathway for those with higher income — the Medically Needy Income Level (MNIL) is $425 per month for a single individual. Medical expenses above that threshold are used to spend down countable income. SSI recipients automatically qualify for Medical Assistance.
• Long-term care (nursing home and waiver services): Income limit of approximately $2,982 per month (the federal Special Income Level). Community Spouse Resource Allowance (CSRA) ranges from $32,532 to $162,660. Home equity exemption limit is approximately $752,000.

Who Qualifies — Residency, Citizenship, and Other Requirements

To qualify for Pennsylvania Medical Assistance, you must meet these baseline requirements in addition to the income limits:

• Pennsylvania residency: You must live in Pennsylvania. Residency can be established with a utility bill, lease, bank statement, or other document showing a Pennsylvania address. People without a fixed address can use a shelter or service provider’s address.
• U.S. citizenship or qualified immigrant status: U.S. citizens and many lawfully-present immigrants qualify. Qualified immigrants include lawful permanent residents, refugees, asylees, and other categories with varying federal waiting periods. Pennsylvania follows federal rules on immigrant eligibility. Undocumented individuals are generally not eligible for full Medical Assistance but may qualify for emergency Medicaid for life-threatening conditions.
• Social Security Number: Required for each person applying for whom you are seeking coverage.
• No asset test for MAGI groups: Adults 19–64, children, and pregnant women applying under MAGI rules have no asset test. Savings, a car, and other resources do not affect eligibility for these groups.

SSI (Supplemental Security Income) recipients automatically qualify for Pennsylvania Medical Assistance. There is no separate Medical Assistance application required for SSI recipients — enrollment is coordinated automatically.

How to Apply for Pennsylvania Medical Assistance (Step by Step)

Applying for Pennsylvania Medical Assistance is free. Here is the step-by-step process for 2026:

1. Apply online at COMPASS — Go to compass.state.pa.us. COMPASS is Pennsylvania’s online benefits portal and is the recommended starting point for most applicants. The application takes approximately 20 minutes to complete and screens you simultaneously for Medical Assistance, SNAP food benefits, CHIP (for children), LIHEAP (energy assistance), and other programs. You can save your progress and return if needed. Track your application status using the “Track My Benefits” feature.
2. Call 1-866-550-4355 — DHS’s customer service line can answer eligibility questions, assist with the application, and connect you with your local County Assistance Office.
3. Apply in person or by mail at your County Assistance Office (CAO) — Pennsylvania processes Medical Assistance eligibility through County Assistance Offices. You can apply in person at your local CAO or request that a paper application be mailed to you. CAO staff can assist with completing your application and gathering required documentation.
4. Decision timeline: Most Medical Assistance decisions are made within 30 days of submitting a complete application. Disability-related and long-term care applications may take 45 to 90 days due to the additional verification and assessment requirements. If you have not received a decision within the required timeframe, contact your CAO or call 1-866-550-4355.
5. Coverage start date and retroactive coverage: Coverage typically begins the month in which you apply. Up to 3 months of retroactive coverage may also be available — if you had eligible medical expenses in the three months before you applied and you were eligible during that period, those bills may be covered. Inform your CAO if you want retroactive coverage considered.
6. Presumptive eligibility for pregnant women: If you are pregnant, certain qualified providers (hospitals, clinics, FQHCs) can grant temporary Medical Assistance coverage while your full application is processed. This ensures prenatal care can begin immediately without waiting for a formal eligibility determination.
7. If denied: Your denial notice must explain the reason and include instructions for filing an appeal. Follow those instructions carefully — you typically have a limited window to request a fair hearing.

After enrollment, you are required to report changes in income, household size, or address to your CAO promptly. Changes that could affect your eligibility must be reported so your coverage category and benefit amount can be adjusted accordingly. For broader guidance on the application process, see our page on how to apply for Medicaid.

Pennsylvania-Specific Programs

Pennsylvania has several long-term care and disability-related programs that are distinctive and worth understanding if you or a family member might need them:

Community HealthChoices (CHC): Pennsylvania’s mandatory managed long-term care program for dual-eligible individuals (those who qualify for both Medicare and Medicaid) and adults with physical disabilities who need long-term services and supports. CHC is now implemented statewide and replaced the older Long-Term Care managed care waiver programs. Under CHC, eligible individuals receive a coordinated package of medical care and long-term services — including home and community-based services (personal care, home health, adult day services) — through a single managed care organization. If you or a family member qualifies for both Medicare and Medicaid and needs ongoing assistance with daily activities, CHC is the primary program to know about.

LIFE Program (PACE — Program of All-Inclusive Care for the Elderly): Pennsylvania’s LIFE program is based on the federal PACE model and serves dual-eligible adults age 55 and older who need nursing home level of care but want to remain in the community. LIFE provides a comprehensive, integrated care package including medical care, adult day services, prescription drugs, and transportation — all coordinated through interdisciplinary care teams. Participants typically attend a LIFE center several days per week. Availability is limited by geography, as LIFE programs only operate in certain areas of Pennsylvania.

OBRA Waiver: The OBRA Waiver is a Medical Assistance waiver program for adults under 60 with physical disabilities who need home and community-based services. It includes a self-direction option that allows participants to hire and manage their own personal care attendants — including, in some cases, family members. The waiver has limited slots and may involve a waiting period. It is administered through the Office of Long-Term Living (OLTL).

Transitional Medical Assistance (TMA): If your income increases above the Medical Assistance limit because of new employment or a pay raise, you may qualify for Transitional Medical Assistance — a temporary extension of coverage that lasts 6 to 12 months while your income exceeds the standard threshold. TMA is designed to prevent coverage gaps during the transition from Medicaid to employer-sponsored or marketplace insurance. Ask your CAO about TMA if your income is expected to rise above the eligibility limit due to work.

Medically Needy spend-down for ABD: For aged, blind, and disabled individuals whose income exceeds standard Medical Assistance limits, Pennsylvania offers a Medically Needy pathway with a spend-down. The Medically Needy Income Level (MNIL) is $425 per month for a single individual. Documented medical expenses above the MNIL reduce countable income until it reaches the threshold. This is different from the Miller Trust / QIT approach used in some other states — consult a Pennsylvania elder law attorney for guidance on LTC planning.

Important 2026–2027 Changes to Know

Pennsylvania Medical Assistance is undergoing significant changes in 2026 and 2027 that current enrollees and applicants need to understand and prepare for:

Federal work requirements phasing in starting December 2026: Under federal law, non-exempt expansion adults ages 19–64 will be required to document 80 hours per month of qualifying activities — including employment, job search, vocational education, job skills training, community service or volunteering, and caregiving — to maintain Medical Assistance eligibility. Pennsylvania is implementing these requirements as mandated, with full phase-in targeted by December 2026.

If you are already working 80 or more hours per month, pay stubs or employer verification will typically satisfy the requirement. If you are not currently working, qualifying activities such as volunteering, job training, or caregiving may also count. Many exemptions apply: you are exempt if you are pregnant or within 12 months postpartum, caring for a child under 6 or a dependent with a disability, medically frail, enrolled as a full-time student, in substance use disorder treatment, or meeting other defined criteria. Start keeping records of your work and qualifying activities now so you are prepared when the documentation requirement goes live.

Six-month renewal cycles phasing in starting December 2026: Certain Medical Assistance categories will shift from annual to 6-month eligibility renewals starting in December 2026. More frequent renewals mean more opportunities for coverage to lapse if you don’t respond to renewal notices in time. A significant number of Pennsylvanians lost Medical Assistance coverage during the recent Medicaid unwinding period simply because renewal forms were not returned — missing a renewal is the most common reason people lose coverage they still qualify for. Update your mailing address and contact information through COMPASS immediately to ensure renewal notices reach you.

See also our guide on Pennsylvania assistance programs for other benefits available to residents alongside Medical Assistance.

Common Mistakes to Avoid

These are the most frequent errors Pennsylvanians make when navigating Medical Assistance eligibility:

• Not applying because you’re childless or single: Pennsylvania’s Medicaid expansion specifically covers adults without children. If you’re under 65, legally present, and earn below approximately $1,836 per month, you qualify. You don’t need to be a parent, pregnant, or disabled to get coverage through the expansion group.
• Assuming a job disqualifies you: Employment does not disqualify you from Medical Assistance. Millions of Pennsylvanians who work — part-time, full-time, or in gig roles — are enrolled in Medical Assistance because their income falls below the 138% FPL threshold. The program is specifically designed for working people who lack access to affordable employer coverage.
• Not returning renewal forms — the most common cause of lost coverage: During Pennsylvania’s recent Medicaid unwinding process, a substantial number of people lost coverage not because they were ineligible but because renewal paperwork was not completed and returned. Make sure your contact information is current in COMPASS, respond to all renewal notices promptly, and don’t let mail go unreviewed.
• Forgetting CHIP for children who earn over the Medicaid limit: Children’s Medical Assistance covers up to 215–220% FPL. Above that, CHIP covers children up to 319% FPL. A family with income above the Medicaid limit but below 319% FPL should apply for CHIP for their children — many families eligible for CHIP don’t apply because they assume their income is too high for any public program.
• Not preparing for work-requirement documentation in late 2026: If you are in the expansion group and not exempt from the work requirement, you will need to document 80 hours per month of qualifying activities starting in late 2026. Start tracking your work hours, training participation, or volunteer activities now so you are ready when the documentation requirement takes effect.
• Assuming Pennsylvania uses Miller Trusts for long-term care: Pennsylvania’s Medically Needy spend-down program is different from the QIT/Miller Trust approach. If you are planning for LTC Medicaid in Pennsylvania, consult a Pennsylvania elder law attorney who is familiar with the state’s specific rules, including the MNIL of $425 per month for a single individual.

Frequently Asked Questions

What is the income limit for Pennsylvania Medicaid (Medical Assistance) in 2026?

Adults ages 19–64 qualify up to 138% FPL — approximately $1,836 per month for one person or $45,540 per year for a family of four — with no asset test. Children qualify up to approximately 215–220% FPL through Medical Assistance and up to 319% FPL through CHIP. Pregnant women qualify up to approximately 215–220% FPL.

What is Medical Assistance?

Medical Assistance (MA) is Pennsylvania’s name for its Medicaid program. It provides free or very low-cost comprehensive health coverage to eligible Pennsylvania residents and is administered by the Department of Human Services (DHS). Medical Assistance covers the same core services as Medicaid in other states — doctor visits, hospital care, prescriptions, behavioral health, dental, and vision — delivered through managed care plans.

Can I get Pennsylvania Medical Assistance if I work?

Yes. Eligibility for Medical Assistance is based on income, not employment status. Many working Pennsylvanians — in part-time, full-time, or gig roles — are enrolled in Medical Assistance because their income falls at or below 138% FPL. Having a job does not disqualify you from the program.

How do I apply for Pennsylvania Medical Assistance?

Apply online through COMPASS at compass.state.pa.us (recommended — takes about 20 minutes and screens for multiple programs), call 1-866-550-4355, or apply in person or by mail at your County Assistance Office. Most decisions are made within 30 days; disability and long-term care applications may take 45–90 days.

Does Pennsylvania Medicaid cover children above the income limit?

Yes — children who earn too much for Medical Assistance (above approximately 215–220% FPL) may qualify for CHIP, which covers children up to 319% FPL. CHIP is free for families below about 235% FPL and has modest premiums above that level. Apply through COMPASS, which screens for both programs simultaneously.

What is Community HealthChoices (CHC)?

Community HealthChoices is Pennsylvania’s mandatory managed long-term care program for dual-eligible individuals (those who qualify for both Medicare and Medicaid) and adults with physical disabilities needing long-term services and supports. CHC coordinates medical care and home/community-based services through a single managed care organization and is now available statewide.

What is Transitional Medical Assistance?

Transitional Medical Assistance (TMA) is a temporary extension of Medical Assistance coverage — lasting 6 to 12 months — for people whose income rises above the standard Medical Assistance limit due to new employment or a pay increase. It is designed to prevent coverage gaps while people transition from Medicaid to employer or marketplace coverage. Ask your County Assistance Office about TMA if your income is about to exceed the threshold.

What are Pennsylvania Medicaid work requirements?

Federal work requirements for non-exempt expansion adults ages 19–64 are phasing into Pennsylvania Medical Assistance starting December 2026. The requirement is 80 hours per month of qualifying activities. Many exemptions apply for pregnancy, caregiving, disability, and other circumstances. Details on the documentation process are still being finalized — monitor dhs.pa.gov for updates.

What other assistance is available in Pennsylvania?

SNAP food benefits have separate eligibility rules from Medical Assistance. See our guide on Pennsylvania food stamps for 2026 income limits. For the full range of Pennsylvania benefit programs, see our Pennsylvania assistance programs guide.

Official Sources

• Pennsylvania Department of Human Services — Medical Assistance: dhs.pa.gov
• COMPASS (apply online): compass.state.pa.us
• Customer service: 1-866-550-4355
• PA Office of Long-Term Living (CHC, LIFE, OBRA): dhs.pa.gov/oltl
• Medicaid.gov — Pennsylvania

Last reviewed: July 2026. Not affiliated with any government agency. Medicaid rules and figures change — confirm your situation with Pennsylvania DHS at dhs.pa.gov or call 1-866-550-4355.