Pennsylvania Medicaid Income Limits 2026: MA and CHIP

Applying is free, and Medical Assistance is health coverage, not a cash grant. To compare Pennsylvania with other states, see our national Medicaid income limits guide.

Pennsylvania Medicaid Income Limits by Household Size (2026)

Pennsylvania sets 4 MAGI income standards plus a CHIP scale, and each one depends on age or pregnancy rather than a single statewide figure. According to the DHS Medical Assistance Eligibility Handbook's 2026 MAGI chart, a household of four can have up to $908 a month under the parent/caretaker group, $3,795.50 under the adult group, $4,455.50 for a child age 1 to 5 and $6,050.50 for a pregnant woman or infant. The amounts are gross monthly income, before taxes.

Source: Pennsylvania DHS, MA Eligibility Handbook Appendix A, 2026 Income Limits for MAGI Coverage Groups (opens in a new tab). The three middle columns are the handbook's "income limit" figures, which already add the 5% disregard to the base percentage. DHS's poverty guidelines page gives January 13, 2026 as the effective date for the 2026 figures.

\ DHS publishes CHIP limits as yearly ranges in its CHIP Income Guidelines Chart (opens in a new tab), effective March 1, 2026. Grantsights divided the yearly figures by 12 and rounded to the dollar. Above the low-cost column, families can still buy full-cost CHIP; there's no upper income limit.*

Yearly equivalents for adults and CHIP

Sources: DHS Federal Poverty Income Guidelines page (opens in a new tab) ("Medicaid Income Requirements (138% of FPIG)," effective January 13, 2026) and the 2026 CHIP chart. DHS lists +$7,839 a year for each adult-group household member beyond eight.

Seniors, disability and long-term care limits

Pennsylvania doesn't use the MAGI chart for people who qualify by age 65+, blindness or disability. The main full-coverage group is Healthy Horizons, and nursing home care has its own test.

Sources: DHS MA Handbook Chapter 319, Appendix A (opens in a new tab) and Appendix B (opens in a new tab); Long-Term Care Handbook Chapter 468, Appendix A (opens in a new tab) and Chapter 440, Appendix A (opens in a new tab); MA Handbook Chapter 316 (MAWD) (opens in a new tab).

People who get SSI are covered by Medical Assistance without a separate income test. The LTC handbook lists Pennsylvania's 2026 SSI payment for one person, with the state supplement, as $1,016.10 a month.

How Pennsylvania Counts Your Income

Pennsylvania runs 2 separate income systems, and the County Assistance Office (CAO) picks the one that fits your situation.

MAGI rules cover children through 18, parents and caretakers, pregnant women and adults 19 to 64, according to Section 312.1 of the DHS handbook. Income is based on the federal tax definition: wages, net self-employment profit, unemployment pay, taxable alimony and Social Security benefits count, while child support you receive and SSI don't. The household follows tax-filing rules, so it's usually you, a spouse and anyone you claim as a dependent. A pregnant woman counts herself plus each expected baby. MAGI groups have no resource test, which Section 312.18 states directly.

The 5% disregard is a deduction equal to 5% of the poverty guideline for your household size. According to the 2026 MAGI income data in the DHS handbook, the disregard is $66.50 a month for one person, $113.85 for three and $137.50 for four. It's why the adult limit for one person shows as $1,769 on DHS's percentage tables but $1,835.50 on the income limit chart. The handbook notes that the disregard doesn't apply to every MAGI category, and the parent/caretaker column above has none added.

Non-MAGI rules cover Healthy Horizons, nursing home care, home and community-based services, Medicare cost-sharing and the medically needy groups. These use SSI-style counting, allow certain deductions, and check what you own as well as what you earn.

For example, a family of three in Pennsylvania earning $3,200 a month gross (one parent, a 4-year-old and a 9-year-old) gets three different answers. The parent is specifically $58.15 over the $3,141.85 adult limit, so the parent doesn't qualify for Medical Assistance. The 4-year-old qualifies, since the age 1 to 5 limit for three is $3,688.85. The 9-year-old is over the age 6 to 18 limit (the same $3,141.85) but well under free CHIP's $56,826 a year, because $3,200 a month is $38,400 a year. That household ends up with one child on Medical Assistance, one on free CHIP, and a parent shopping on Pennie, the state's marketplace.

Pennsylvania Medicaid Asset Limits

$2,000 is the resource limit for one person in Healthy Horizons and in the nursing home special income group, and $3,000 applies when the Healthy Horizons family has two or more people, according to the DHS handbook's Chapter 319 Appendix A (effective January 1, 2026). Adults, parents, children and pregnant women on MAGI coverage don't face an asset test at all.

Long-term care has three different resource standards, which is a common source of confusion:

• $2,000 plus a $6,000 disregard for people whose nursing home eligibility is figured under the $2,982 special income limit. In practice, a single person in this group can keep about $8,000 in countable resources. The LTC handbook says the $6,000 disregard applies only to this group.
• $2,400 for the medically needy only (MNO) route.
• Spousal protection: when one spouse needs nursing home care, the spouse at home keeps a share of the couple's resources. According to the LTC handbook's resource appendix, the 2026 spousal share runs from a minimum of $32,532 to a maximum of $162,660.

The LTC handbook also sets a $60 a month personal needs allowance (effective January 1, 2025) that a nursing home resident keeps from their income; most of the rest goes toward the cost of care. Transfers of money or property for less than fair market value during the look-back period can delay coverage, so a family planning ahead should talk with a legal aid office or an elder law attorney before moving assets.

Expansion vs Non-Expansion: Pennsylvania's Position in 2026

Pennsylvania expanded Medicaid, so 133% of poverty plus the 5% disregard covers adults 19 to 64 whether or not they have children. The Medicaid.gov eligibility levels table (opens in a new tab) (as of December 1, 2023) lists Pennsylvania at 133% for expansion adults, 33% for parents and caretakers, 215% for pregnant women and infants, and 314% for separate CHIP. In a non-expansion state the picture is very different; our Texas Medicaid income limits guide shows what happens to adults without children there. Neighboring guides for Ohio, Michigan and North Carolina cover other expansion states.

What changes on January 1, 2027. According to the DHS Medicaid changes page, the 2025 federal reconciliation law brings these changes to Pennsylvania:

• Work and community engagement requirement for adults 19 to 64 who get Medicaid through expansion and don't have a dependent child under 14. They'll need 80 hours a month of work, volunteering, community service, job training or school (part-time school counts), or monthly income of at least $580.
• Renewals every 6 months for some adults 19 to 64. According to the DHS Medicaid changes guide, a member whose coverage starts in January 2027 renews in July 2027. Current members switch after their next renewal completed in or after February 2027.
• Shorter retroactive coverage. Expansion adults can get coverage for 1 month before the application month instead of 3; everyone else gets 2 months.
• Coverage doesn't stop on January 1. Current members report that they meet the requirement, or an exemption, at their next 2027 renewal.

Exemptions DHS lists include parents or caretakers of a child under 14 or of a person with a disability; people who are pregnant or postpartum; tribal members; veterans with a total disability rating; people in treatment for a substance use disorder; people released from prison or jail in the last 4 months; former foster youth under 26; people meeting TANF or SNAP work rules; people who are medically frail; and people with a short-term hardship such as a recent hospital or nursing facility stay.

Already in effect: under DHS Operations Memorandum 26-09-01 (opens in a new tab) (September 14, 2026), federally funded Medical Assistance for noncitizens narrowed on October 1, 2026 to lawful permanent residents, Cuban or Haitian entrants and COFA migrants, with exceptions for lawfully present children under 21 and pregnant or postpartum people. None of these changes alter the dollar limits above.

What Pennsylvania DHS Doesn't Tell You About the Income Limits

Grantsights found 5 gaps between how DHS publishes its limits and how they work for a real household:

1. The parent limit is tiny, but it rarely matters. The parent/caretaker group stops at $752 a month for three. Most working parents qualify instead through the adult group at $3,141.85. Grantsights analysis of the 2026 MAGI chart shows the adult group covers $2,389.85 more a month than the parent group for a three-person household, so a parent who reads only the 33% figure may wrongly assume they're shut out.
2. Two numbers for the same limit. DHS's percentage tables show 133% ($1,769 for one person) while the handbook's income limit column shows $1,835.50. The higher one is what the CAO actually uses for adults.
3. Children's limits fall as kids get older. A baby qualifies up to 215% of poverty, a preschooler up to 157% and a school-age child up to 133%, all in the same family. Siblings can end up split between Medical Assistance and CHIP.
4. CHIP is the bigger safety net for kids. Grantsights analysis of the 2026 CHIP chart against the MAGI chart found that free CHIP for a family of four reaches $5,720 a month, $1,924.50 above the $3,795.50 limit for a school-age child on Medical Assistance. Many families underestimate how far up the income scale free CHIP goes. One COMPASS application checks a child for both Medical Assistance and CHIP.
5. Senior limits sit on different pages. Healthy Horizons, nursing home and Medicare savings limits are in separate handbook chapters from the MAGI chart. A 70-year-old who checks the $1,835.50 adult figure is using the wrong test; the senior limit is $1,330 plus a $2,000 resource cap.

Pennsylvania's own Medicaid general eligibility page (opens in a new tab) gives the program overview, but the dollar figures above come from the handbook appendices, which update separately.

Common Mistakes and Red Flags

These errors cause most wrong answers on Pennsylvania eligibility:

• Using take-home pay. All MAGI limits are gross income. Pre-tax retirement and health contributions come off; taxes don't.
• Counting the wrong people. A common mistake is leaving an expected baby out of the household or adding a roommate who isn't in your tax household.
• Assuming a 2025 denial still stands. The one-person adult limit rose from $1,800.25 in 2025 to $1,835.50 in 2026, and the four-person limit from $3,698.00 to $3,795.50, according to the handbook's year-by-year charts.
• Skipping the kids after a parent is denied. Each person is checked separately, and CHIP has no upper income limit.
• Paying someone to apply. Applying for Medical Assistance or CHIP is free. A red flag is any website, caller or "benefits service" that asks for a fee, gift cards or your bank login to file for you. County Assistance Offices and DHS never charge.
• Missing renewal mail. Starting in 2027, many expansion adults renew every 6 months, and a missed request for information is one of the fastest ways to lose coverage you still qualify for. DHS gives 30 days to answer its letters.

How to Apply for Pennsylvania Medical Assistance and How Long It Takes

Section 304.5 of the DHS MA Eligibility Handbook (opens in a new tab) gives the CAO 30 days to decide an application, extended to 45 days if the office sends a notice explaining the delay. The ACCESS card usually arrives within 7 days of approval. In a medical emergency, ask the CAO to speed up processing; the handbook sets a target of five business days after the request.

1. Online: through COMPASS (opens in a new tab), which also has the myCOMPASS PA app for uploading documents.
2. By phone: the DHS Customer Service Center at 1-877-395-8930 (215-560-7226 in Philadelphia), the number DHS lists on its Medicaid changes page. For CHIP questions, DHS lists 1-800-986-KIDS.
3. In person or by mail: at your County Assistance Office, using the PA 600 series application.

Have pay stubs or a recent tax return, Social Security numbers, and proof of identity and immigration status ready. For senior, disability or nursing home applications, add bank statements, life insurance and property records. If you also need food help, our Pennsylvania food stamps guide covers SNAP, which uses different limits.

What to Do If You're Denied

You have 30 days from the date of the written notice to appeal a Medical Assistance or CHIP decision, under Section 870.1 of the DHS Supplemental Handbook (opens in a new tab). If the CAO never acted on your application, you have 60 days. Appeal within 15 days of a notice that ends or cuts your coverage and your benefits can continue until the hearing decision.

Start with the reason on the notice. If it's income, compare the CAO's figure with your gross pay and your household size, and check whether the 5% disregard was applied. Household-size errors and outdated pay stubs are fixable. Legal aid offices in Pennsylvania can help with hearings at no cost.

If You're Over the Pennsylvania Medicaid Limit

Being $100 over the adult line still leaves at least 6 other routes worth checking, and for families with children your best bet is usually CHIP. According to the Pennsylvania CHIP program chart, a family of four earning $90,000 a year pays an average premium of $91 a month per child in the middle low-cost tier, while a family under $68,640 pays nothing.

• Pennie marketplace: adults over 138% can buy coverage with premium tax credits; see HealthCare.gov's savings page (opens in a new tab) for how the credits work. Pennsylvania runs its own marketplace, Pennie, and losing Medical Assistance opens a special enrollment period.
• CHIP for the kids: free up to about 208% of poverty and low-cost up to about 314%, with full-cost coverage above that.
• Medicare savings programs: if you have Medicare, SLMB covers the Part B premium up to $1,596 a month for one person, and DHS's 2026 FPIG table lists the QI-1 limit at 135% ($1,796).
• MAWD: a worker with a disability can qualify at income under 250% of poverty with up to $10,000 in resources.
• WIC serves pregnant women, new mothers and children under 5 up to 185% of poverty: see our WIC income limits guide.
• Older adults and people with disabilities: our SSI income limits guide and help for seniors programs guide cover cash and service programs.

Our federal poverty guidelines guide lists every percentage band, our SNAP income limits guide covers food help, and our LIHEAP income limits guide covers heating bills. If you need help beyond health coverage, Grantsights' free eligibility checker can point you to official programs for rent, utilities and other needs. It doesn't decide Medical Assistance eligibility and doesn't file anything for you; it shows where to apply.

FAQ: Pennsylvania Medicaid Income Limits

What is the income limit for Pennsylvania Medicaid in 2026?

$1,835.50 a month for one adult and $3,795.50 for four, effective January 13, 2026.

How much can a family of 4 make and get Medical Assistance in PA?

$3,795.50 a month for the adults; children 1 to 5 up to $4,455.50; free CHIP up to $68,640 a year.

What is the Pennsylvania Medicaid income limit for pregnant women?

$3,968.20 a month for a household of two and $5,008.85 for three.

What is the CHIP income limit in Pennsylvania?

No upper limit; free up to $68,640 a year for four, low-cost up to $103,620.

What are the Medicaid income and asset limits for seniors in Pennsylvania?

$1,330 a month and $2,000 in resources for one person under Healthy Horizons.

What is the income limit for nursing home Medicaid in Pennsylvania?

$2,982 a month in 2026, with a medically needy route for people over it.

When do Pennsylvania Medicaid work requirements start?

January 1, 2027, for expansion adults without a child under 14, unless exempt.

How long do I have to appeal a Medical Assistance denial in Pennsylvania?

30 days from the notice date; 15 days to keep benefits during the appeal.

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Sources

1. Pennsylvania DHS: MA Eligibility Handbook Appendix A, 2026 Income Limits for MAGI Coverage Groups (opens in a new tab), updated May 19, 2026
2. Pennsylvania DHS: MA Eligibility Handbook Section 312.1, MAGI General Policy (opens in a new tab) - groups, percentages and no resource test
3. Pennsylvania DHS: Federal Poverty Income Guidelines (opens in a new tab) - 138% yearly limits effective January 13, 2026; QI-1 and MAWD percentages
4. Pennsylvania DHS: 2026 CHIP Income Guidelines Chart (opens in a new tab), effective March 1, 2026
5. Pennsylvania DHS: MA Handbook Chapter 319, Appendix A (Healthy Horizons) (opens in a new tab) and Appendix B (SLMB) (opens in a new tab)
6. Pennsylvania DHS: Long-Term Care Handbook Chapter 468, Appendix A (opens in a new tab) - $2,982 special income limit, MNO limit, personal needs allowance
7. Pennsylvania DHS: Long-Term Care Handbook Chapter 440, Appendix A (opens in a new tab) - LTC resource limits and 2026 spousal share
8. Pennsylvania DHS: MA Handbook Chapter 316, MAWD General Policy (opens in a new tab)
9. Pennsylvania DHS: Medicaid Changes (opens in a new tab) - work requirements, six-month renewals and retroactive coverage from January 1, 2027
10. Pennsylvania DHS: Operations Memorandum 26-09-01 (opens in a new tab), September 14, 2026 - noncitizen eligibility from October 1, 2026
11. Pennsylvania DHS: MA Handbook Section 304.5, Processing an Application (opens in a new tab)
12. Pennsylvania DHS: Supplemental Handbook Section 870.1, Appeal and Fair Hearing (opens in a new tab)
13. Pennsylvania DHS: Medicaid General Eligibility (opens in a new tab)
14. HHS ASPE: 2026 Poverty Guidelines (opens in a new tab)
15. Federal Register: Cost-of-Living Increase and Other Determinations for 2027 (opens in a new tab), October 26, 2026 - 2026 and 2027 SSI rates
16. Medicaid.gov: Medicaid, CHIP and BHP Eligibility Levels (opens in a new tab), as of December 1, 2023
17. HealthCare.gov: Lower costs on Marketplace coverage (opens in a new tab)