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
Pennsylvania Medical Assistance (Medicaid)
Visit the official Pennsylvania Medicaid websiteRelated guides
Income Limits
Current income cutoffs by state and household size, tied to the Federal Poverty Level.
Read more →Spend-Down
How to qualify by deducting medical bills from income that's above the limit.
Read more →Eligibility Requirements
The income, household, age, and state rules that determine who qualifies.
Read more →