Pennsylvania Medical Assistance income limits 2026

Last verified: June 2026

Pennsylvania Medical Assistance income limits by coverage group (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.

Source: Pennsylvania DHS HealthChoices Income Requirements table (effective January 13, 2026); pa.gov federal poverty income guidelines. Dollar figures are approximate annual equivalents based on 2026 HHS FPL. Verify current thresholds at pa.gov or through COMPASS.

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.

Add $7,839/year per additional person above 8. Source: Pennsylvania DHS HealthChoices Income Requirements, effective January 13, 2026. Based on 2026 federal poverty income guidelines. Monthly figures are approximations.

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.

What counts 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.