Pennsylvania Medicaid Income Limits

Updated August 2026

Medical Assistance income limits are set as percentages of the Federal Poverty Level (FPL), which HHS updates annually in January. Pennsylvania applies the current-year FPL for all Medical Assistance eligibility determinations. The coverage groups and their income thresholds differ significantly — children in Pennsylvania qualify at a higher income than most other states.

138% FPL

Adults 19–64

215% FPL

Pregnant women

317% FPL

CHIP (children)

No asset test

MAGI-based groups

How income is counted for Medical Assistance eligibility

Pennsylvania uses Modified Adjusted Gross Income (MAGI) rules for the ACA expansion group, pregnant women, and children. Under MAGI, most Social Security income and tax-exempt interest are excluded from the calculation. The unborn child counts as a household member when determining the FPL threshold for pregnant women, which effectively raises the income limit. Self-employment income is counted as net earnings (gross income minus allowable business expenses). Child support received is not counted as income for the MAGI group.

Pennsylvania Medical Assistance income limits by coverage group (2026)

Coverage group	Income limit	~Annual (1 person)
Adults ages 19–64 (ACA expansion)	138% FPL	~$22,025/yr
Pregnant women (Healthy Beginnings Plus)	215% FPL	~$34,357/yr
Children (Medical Assistance) under 138% FPL	138% FPL	~$22,025/yr
Children (CHIP) ages 0–18	Up to 317% FPL	No upper limit (full-cost available)
SSI recipients (aged, blind, disabled)	SSI limit	Automatic eligibility
Working adults with disabilities (MA-WD)	Up to 250% FPL	~$39,900/yr
Former foster care youth (under 26)	No income limit	Covered regardless of income

Adults ages 19–64 (ACA expansion)

Income limit: 138% FPL
~Annual (1 person): ~$22,025/yr

Pregnant women (Healthy Beginnings Plus)

Income limit: 215% FPL
~Annual (1 person): ~$34,357/yr

Children (Medical Assistance) under 138% FPL

Income limit: 138% FPL
~Annual (1 person): ~$22,025/yr

Children (CHIP) ages 0–18

Income limit: Up to 317% FPL
~Annual (1 person): No upper limit (full-cost available)

SSI recipients (aged, blind, disabled)

Income limit: SSI limit
~Annual (1 person): Automatic eligibility

Working adults with disabilities (MA-WD)

Income limit: Up to 250% FPL
~Annual (1 person): ~$39,900/yr

Former foster care youth (under 26)

Income limit: No income limit
~Annual (1 person): Covered regardless of income

Adult Medical Assistance income limits by household size (2026)

The table below shows the exact annual income limits for adult Medical Assistance (138% FPL), as published by Pennsylvania DHS effective January 13, 2026. These are the amounts DHS uses to determine eligibility — not estimates.

Household size	Annual income limit (138% FPL)	Monthly equivalent
1 person	$22,025	~$1,835/mo
2 people	$29,864	~$2,489/mo
3 people	$37,702	~$3,142/mo
4 people	$45,540	~$3,795/mo
5 people	$53,379	~$4,448/mo
6 people	$61,217	~$5,101/mo
7 people	$69,056	~$5,755/mo
8 people	$76,894	~$6,408/mo
Each additional person	add $7,839/year	—

1 person

Annual income limit (138% FPL): $22,025
Monthly equivalent: ~$1,835/mo

2 people

Annual income limit (138% FPL): $29,864
Monthly equivalent: ~$2,489/mo

3 people

Annual income limit (138% FPL): $37,702
Monthly equivalent: ~$3,142/mo

4 people

Annual income limit (138% FPL): $45,540
Monthly equivalent: ~$3,795/mo

5 people

Annual income limit (138% FPL): $53,379
Monthly equivalent: ~$4,448/mo

6 people

Annual income limit (138% FPL): $61,217
Monthly equivalent: ~$5,101/mo

7 people

Annual income limit (138% FPL): $69,056
Monthly equivalent: ~$5,755/mo

8 people

Annual income limit (138% FPL): $76,894
Monthly equivalent: ~$6,408/mo

Each additional person

Annual income limit (138% FPL): add $7,839/year
Monthly equivalent: —

Why Pennsylvania's children's income limit is higher than most states

Pennsylvania covers children through CHIP up to 317% FPL — well above the federal minimum of 200% FPL and higher than most neighboring states. A family of four with annual income up to approximately $100,951 can access free or low-cost CHIP coverage for their children, per the 2026 CHIP income guidelines. Children whose household income falls below 138% FPL are enrolled directly in Medical Assistance rather than CHIP.

Pennsylvania's CHIP program uses a tiered structure: free coverage for households below the "free" income threshold, low-cost tiers with premiums of $90–$115/month per child, and full-cost coverage for families above the upper CHIP limit (approximately $49,141/year for a household of one). CHIP is administered separately from Medical Assistance — see the CHIP page for details.

Pennsylvania Medical Assistance has no asset test for most applicants

MAGI-based Medical Assistance — the program covering most adults 19–64, children, and pregnant women — has no asset test. A savings account, car, or home does not count against you. Pennsylvania does not count resources for this group.

Non-MAGI categories — primarily seniors and people with disabilities applying through SSI-linked or non-MAGI pathways, and nursing facility applicants — are subject to asset or resource limits. For nursing facility applicants, the standard individual resource limit is $8,000. Community spouses (the at-home spouse of a nursing facility resident) retain a Community Spouse Resource Allowance (CSRA) of up to approximately $154,140 under federal rules (2026 figures — verify with DHS for the current amount).

If you are applying for long-term care Medical Assistance, consult a benefits counselor or elder law attorney before transferring any assets. Pennsylvania enforces a 60-month (five-year) look-back period for asset transfers made before a nursing facility application.

How Pennsylvania's limits compare to neighboring states

Comparison approximate as of 2025–2026. Pennsylvania's CHIP limit of 317% FPL is notably higher than most neighboring states, covering a larger share of middle-income families.

State	Adults (expansion)	Pregnant women	CHIP upper limit
Pennsylvania	138% FPL	215% FPL	317% FPL
New York	138% FPL	223% FPL	400% FPL
New Jersey	138% FPL	205% FPL	355% FPL
Ohio	138% FPL	206% FPL	211% FPL

Pennsylvania

Adults (expansion): 138% FPL
Pregnant women: 215% FPL
CHIP upper limit: 317% FPL

New York

Adults (expansion): 138% FPL
Pregnant women: 223% FPL
CHIP upper limit: 400% FPL

New Jersey

Adults (expansion): 138% FPL
Pregnant women: 205% FPL
CHIP upper limit: 355% FPL

Ohio

Adults (expansion): 138% FPL
Pregnant women: 206% FPL
CHIP upper limit: 211% FPL

What counts as income for Pennsylvania Medical Assistance (MAGI rules)

Wages, salaries, and tips
Self-employment net income (gross minus business expenses)
Unemployment compensation
Social Security benefits (taxable portion, mostly)
Alimony received (pre-2019 agreements)
Rental income (net of expenses)
Taxable interest and dividends

What doesn't count as income for Pennsylvania Medical Assistance (MAGI rules)

For pregnant women, the unborn child counts as a household member — this raises the applicable FPL threshold. The ACA also allows a 5% income disregard when determining eligibility at the Medicaid/CHIP boundary for children, which COMPASS applies automatically.

Child support received
SNAP, TANF, and most public benefits
Veterans' benefits (most types)
Gifts, inheritances, and life insurance proceeds
Workers' compensation
SSI payments
Tax-exempt interest

Medicare Savings Programs (QMB) in Pennsylvania

Pennsylvanians who search "Pennsylvania QMB income limits" are usually trying to sort out which of three Medicare Savings Programs — QMB, SLMB, and QI — they qualify for through Pennsylvania's Department of Human Services (DHS). All three are Medical Assistance programs, but they're evaluated under different, more specific income rules than the MAGI-based categories described earlier on this page.

Program	Situation	Monthly income limit
QMB	Individual	$1,350/mo
QMB	Married couple	$1,824/mo
SLMB	Individual	$1,616/mo
SLMB	Married couple	$2,184/mo
QI	Individual	$1,816/mo
QI	Married couple	$2,455/mo

QMB

Situation: Individual
Monthly income limit: $1,350/mo

QMB

Situation: Married couple
Monthly income limit: $1,824/mo

SLMB

Situation: Individual
Monthly income limit: $1,616/mo

SLMB

Situation: Married couple
Monthly income limit: $2,184/mo

Situation: Individual
Monthly income limit: $1,816/mo

Situation: Married couple
Monthly income limit: $2,455/mo

Qualified Medicare Beneficiary (QMB) is the strongest tier: in 2026, an individual qualifies with income up to $1,350/mo and resources up to $9,950, while a married couple qualifies up to $1,824/mo in income and $14,910 in resources. QMB pays your Part A premium if one is owed, your full Part B premium ($202.90/mo in 2026), and every Medicare deductible, coinsurance amount, and copayment. Federal law prohibits any provider — Pennsylvania-based or otherwise — from billing a QMB enrollee for that cost-sharing.

Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) reach further up the income scale but pay only the Part B premium: SLMB up to $1,616/mo individual ($2,184/mo couple), QI up to $1,816/mo individual ($2,455/mo couple). Both use the same resource limits as QMB. QI has a capped annual budget awarded first-come, first-served, so QI enrollees must reapply each year rather than renewing automatically.

Enrollment in any tier brings automatic Extra Help, which caps what you pay for covered Part D prescriptions at $12.65 each in 2026. Apply for a Medicare Savings Program through COMPASS at compass.state.pa.us, by calling 1-866-550-4355, or through your local County Assistance Office (CAO) — the same office that handles the disability and senior categories of Medical Assistance described above. The statewide DHS HelpLine at 1-800-692-7462 can answer general questions if you're not sure where to start.

Pennsylvania Medical Assistance (Medicaid)

Visit the official Pennsylvania Medicaid website

Income Limits in Nearby States

Rhode Island Vermont Connecticut Maine Massachusetts