Pennsylvania Medicaid Income Limits 2026: Medical Assistance by Household Size

Key facts

1Adults ages 19 to 64 (expansion / HealthChoices)

PA DHS Medicaid 138 percent FPIG annual table, effective January 13, 2026. Verified November 5, 2026.

PA DHS general eligibility says adults ages 19 to 64 may qualify with incomes at or below 133 percent of the FPIG. (PA DHS, Medicaid General Eligibility) The same agency posts a dollar table labeled "Medicaid Income Requirements 138% of Federal Poverty Income Guidelines," effective January 13, 2026: (PA DHS, Medicaid) (PA DHS, Federal Poverty Income Guidelines)

Use the table PA DHS publishes for the dollar test, and apply yourself to learn which category you fall in. Starting January 1, 2027, some adults in this group also face work rules and six-month renewals (see below).

2Pregnant women and infants under age one

Pregnant women and infants under one, monthly limits from PA DHS. The matching 215 percent table is effective January 13, 2026. Verified November 5, 2026.

Family income may not exceed 215 percent of the FPIG. When PA DHS sets the limit for a pregnant woman, household size is increased by the number of unborn children. Example from PA DHS: a woman pregnant with twins counts as three persons. (PA DHS, Medical Assistance for Children and Pregnant Women) There are no resource requirements for this category. (PA DHS, Medical Assistance for Children and Pregnant Women)

Coverage for a pregnant woman eligible for and receiving Medicaid continues for one year after the birth. Children are automatically covered up to age one if the mother is eligible for and receiving Medical Assistance on the date of the child's birth. (PA DHS, Medical Assistance for Children and Pregnant Women)

3Children ages one to five

Children ages one to five, monthly limits from PA DHS. Verified November 5, 2026.

Family income may not exceed 157 percent of the FPIG. (PA DHS, Medical Assistance for Children and Pregnant Women)

4Children ages six to under 19

Children ages six to under 19, monthly limits from PA DHS. Verified November 5, 2026.

Family income may not exceed 133 percent of the FPIG. (PA DHS, Medical Assistance for Children and Pregnant Women)

5MAGI parents and caretakers

33 percent FPIG figures from the PA DHS FPIG page for MAGI parents and caretakers. Verified November 5, 2026.

PA DHS lists MAGI parents and caretakers at 33 percent of the FPIG on its Federal Poverty Income Guidelines page. (PA DHS, Federal Poverty Income Guidelines) General eligibility groups parents and caretakers of children under 21 under MAGI Medical Assistance. (PA DHS, Medicaid General Eligibility)

6Medical Assistance for Workers with Disabilities (MAWD)

250 percent FPIG table from PA DHS, labeled for MAWD. Verified November 5, 2026.

MAWD is for people with a disability that meets the Social Security definition, ages 16 to 64, who have a paying job. Countable income must be below 250 percent of the FPIG, and countable resources must be below $10,000 (official resource limit). (PA DHS, Apply for MAWD) (PA DHS, Medicaid General Eligibility) The PA DHS FPIG page posts the 250 percent dollar table and labels that column for MAWD: (PA DHS, Federal Poverty Income Guidelines)

PA DHS says MAWD usually has a small monthly premium of about 5 percent of monthly income. Workers with Job Success can keep MAWD if income rises, as long as income stays under 600 percent of the FPIG. (PA DHS, Apply for MAWD)

7Who may qualify for both Medicare and Medicaid?

In Pennsylvania, people who have Medicare and also meet Medical Assistance rules may get help through Healthy Horizons (Medicare Buy-In) and, if they are 21 or older and have both Medicare and Medicaid, may be enrolled in Community HealthChoices (CHC). (PA DHS, Medicaid for Older People and People with Disabilities) (PA DHS, Community HealthChoices)

Healthy Horizons is for elderly people or people with disabilities who are eligible for Medicare and who meet income and resource limits. (PA DHS, Medicaid for Older People and People with Disabilities)

• Qualified Medicare Beneficiary (QMB), also called Healthy Horizons: Medical Assistance can pay Medicare Part A and Part B premiums plus Medicare deductibles and coinsurance, and QMB categorically needy also gets medical coverage through Medical Assistance. (PA DHS, Medicaid for Older People and People with Disabilities)
• QMB Medicare Cost-Sharing (Healthy Horizons-Medicare Cost-Sharing): pays Part A and Part B premiums plus deductibles and coinsurance. (PA DHS, Medicaid for Older People and People with Disabilities)
• Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individuals Group 1 (QI-1): pay the Medicare Part B premium only. (PA DHS, Medicaid for Older People and People with Disabilities)

PA DHS sets those Healthy Horizons income bands off FPIG percentages (about 100 percent for QMB, at least 100 and under 120 percent for SLMB, at least 120 and under 135 percent for QI-1), with a $20 deductible added in the published monthly limit math. (PA DHS, Medicaid for Older People and People with Disabilities) The Healthy Horizons tables on that page (accessed November 5, 2026) show estimated monthly limits such as $1,350 for one person in QMB ($1,330 plus $20). Those dollar columns are labeled 2025 FPIG on the page; the underlying $1,330 and $1,804 figures match the 2026 100 percent FPIG amounts on the PA DHS FPIG page. (PA DHS, Medicaid for Older People and People with Disabilities) (PA DHS, Federal Poverty Income Guidelines) Resource limits on the same page include $2,000 / $3,000 for QMB categorically needy and $9,950 / $14,910 for the Medicare cost-sharing categories (official resource limits). (PA DHS, Medicaid for Older People and People with Disabilities) (PA DHS, Medicaid General Eligibility)

CHC may enroll people who are 21 or older and are receiving both Medicare and Medicaid, or who meet other long-term support criteria listed on the CHC page. (PA DHS, Community HealthChoices)

8What income counts

Medical Assistance eligibility compares income and household size to the limits above. PA DHS lists examples of counted income such as wages, interest, dividends, Social Security, pensions, and a spouse's income if you live together. Veterans' benefits are counted except for MAGI MA. (PA DHS, Medicaid General Eligibility) So regular Social Security benefits count as income for Medical Assistance. Supplemental Security Income (SSI) is on the not-counted list. Other examples of income not counted include TANF, SNAP, LIHEAP, foster care payments, certain housing or utility subsidies, weatherization payments, and child support (child support is not counted only for MAGI MA). (PA DHS, Medicaid General Eligibility)

Resource limits do not apply for MAGI MA groups, pregnant women, people with children aged 20 and under under their care, or children under 21, with the Medicare Buy-In and MAWD exceptions noted on the general eligibility page. (PA DHS, Medicaid General Eligibility)

9How to apply for Pennsylvania Medical Assistance

You can apply online on COMPASS, by phone at the Consumer Service Center for Health Care Coverage at 1-866-550-4355, in person at a County Assistance Office, or by mail with a paper application. (PA DHS, Medicaid) Track status at trackmybenefits.pa.gov. (PA DHS, Medicaid)

Benefit Bull is free, always. No SSN. Benefit Bull never files for you. You submit the application yourself.

10January 2027 work rules and six-month renewals

Starting January 1, 2027, some adult Medical Assistance applicants and recipients ages 19 to 64 who do not have a dependent child under 14 must report that they are meeting work requirements or an exemption when they apply or renew. (PA DHS, Medicaid Changes) Coverage does not change automatically on January 1. Current recipients report at their next renewal date in 2027. (PA DHS, Medicaid Changes)

Hours and the $580 income path

To meet the work requirement, do one or a mix of these for at least 80 hours a month: work, volunteer or community service, a work training program, or school at least part-time. School at least part-time meets the full requirement. Less than half-time school can be combined with other activities to reach 80 hours. (PA DHS, Medicaid Changes)

You may also meet the requirement with household monthly income of at least $580 (official PA DHS threshold). Seasonal workers may use average monthly income. A caseworker can help with that calculation. (PA DHS, Medicaid Changes)

Exemptions

PA DHS lists exemptions for people who are or were: (PA DHS, Medicaid Changes)

• Parents or caretakers of a child under 14, or of an individual with a disability
• Pregnant or receiving postpartum coverage through Medicaid
• Members of American Indian or Alaska Native tribes
• Veterans with a VA-determined total disability
• In treatment for alcohol or substance use disorder
• In prison or jail in the last 4 months
• Former foster care under age 26
• Meeting TANF work requirements
• Receiving SNAP and subject to SNAP work requirements
• Medically frail or with special medical needs (including blindness or disability, substance use disorder, a disabling mental disorder, significant physical, intellectual, or developmental disabilities that make daily activities hard, or a serious or complex medical condition that makes work requirements hard to meet)

Temporary hardship exemptions include a recent stay in a hospital, nursing facility, assisted living facility, personal care home, psychiatric facility, or other residential care facility, and travel for medical treatment for a serious health condition for yourself or a dependent. (PA DHS, Medicaid Changes)

SNAP recipients who are subject to a SNAP work requirement and also receive Medicaid are excluded from the Medicaid work requirement. (PA DHS, FAQ: Medicaid Changes)

Reporting and renewals

Report work or an exemption at application and at each renewal starting in 2027 through COMPASS, the myCOMPASS PA app, by calling 877-395-8930 (215-560-7226 in Philadelphia), or at a County Assistance Office. (PA DHS, Medicaid Changes) Paid work needs proof such as a pay stub. In 2027, most other activities and exemptions can be self-attested. In 2028, PA DHS says proof will be required. (PA DHS, FAQ: Medicaid Changes)

Some adults ages 19 to 64 will renew every six months instead of every year. New applicants on or after January 1, 2027 renew six months after coverage starts. Current members switch after their next renewal in or after February 2027. (PA DHS, Medicaid Changes)

Retroactive coverage shortens on January 1, 2027 to one month for expansion adults (ages 19 to 64) and two months for all other recipients. (PA DHS, Medicaid Changes)

Update your address in COMPASS, tell the U.S. Postal Service too, and sign up for DHS texts at dhs.pa.gov/text so you get notices. (PA DHS, Medicaid Changes)

Frequently asked questions