Pennsylvania Medicaid Eligibility Guide — 2026

Pennsylvania Medicaid (Medical Assistance)

This guide covers Medicaid eligibility in Pennsylvania, known as Medical Assistance. Whether you're a child, parent, pregnant woman, or adult, this guide explains who qualifies and how to apply.

This guide uses 2026 Federal Poverty Level (FPL) data. The FPL is published annually in January by HHS and determines eligibility thresholds for Medicaid and other federal programs.

Medicaid Pathways

General Eligibility Requirements

To qualify for Pennsylvania Medicaid you must:

• Be a resident of Pennsylvania
• Be a U.S. citizen or have qualified immigration status
• Have or apply for a Social Security number (with some exceptions)
• Meet the specific eligibility criteria for at least one Medicaid pathway
• Meet income guidelines (which vary by program)

This guide covers the main categories: children, pregnant women, parents, and adults. Additional pathways exist for seniors (65+), people with disabilities, and specific medical conditions — these often have different income and asset requirements.

Medicaid Eligibility Pathways in Pennsylvania

Pennsylvania offers several pathways to Medicaid eligibility. A 5% income disregard may already be included or may be applied depending on circumstances.

1. Medicaid for Children

Who qualifies:

• Children under age 19
• Pennsylvania residents
• U.S. citizens or those with qualified immigration status
• Meeting income guidelines below

Income limits:

• Infants up to age 1: up to 215% FPL
• Children ages 1–5: up to 157% FPL
• Children ages 6–18: up to 133% FPL

2. Children's Health Insurance Program (CHIP)

Who qualifies:

• Children under age 19
• Family income above Medicaid limits but at or below 319% FPL
• Pennsylvania residents
• U.S. citizens or those with qualified immigration status
• Not currently covered by other insurance

Income range: above Medicaid children's limit up to 319% FPL

3. Medicaid for Pregnant Women

Who qualifies:

• Pregnant individuals
• Pennsylvania residents
• U.S. citizens or those with qualified immigration status
• Income at or below 215% FPL

Income limits — 215% FPL:

* The unborn child counts as a family member when determining family size. Coverage extends for 12 months postpartum in Pennsylvania. Presumptive eligibility provides temporary coverage for prenatal services while the full application is processed.

4. Medicaid for Adults (ACA Expansion)

Who qualifies:

• Adults ages 19–64
• Not currently eligible for Medicare
• Pennsylvania residents
• U.S. citizens or those with qualified immigration status
• Income at or below 138% FPL

Income limits — 138% FPL:

5. Medicaid for Parents & Caretaker Relatives

Who qualifies:

• Parents or caretaker relatives of dependent children under age 19
• Must live with and provide care for the child
• Pennsylvania residents
• U.S. citizens or those with qualified immigration status
• Meeting income guidelines below

Income limits — 138% FPL:

6. Medically Needy Program

The Medically Needy program helps people with high medical expenses who might not otherwise qualify due to income that exceeds standard limits. Through this program, individuals can "spend down" their income on medical expenses to reach the eligibility threshold — similar to meeting a deductible.

How Income is Counted (MAGI)

Medicaid income limits are based on MAGI — Modified Adjusted Gross Income. This is different from taxable income. To learn exactly how MAGI is calculated, see: How Income is Counted for MAGI →

How to Apply for Medical Assistance

There are several ways to apply for Medicaid in Pennsylvania:

• Online: www.dhs.pa.gov/Services/Assistance/Pages/Medical-Assistance.aspx
• By phone: 1-866-550-4355
• In person: Visit your local Department of Social Services or Medicaid office
• By mail: Request a paper application from your local Medicaid office

ACA Marketplace Coverage

If you don't qualify for Medicaid in Pennsylvania, you may be eligible for subsidized health insurance through the Health Insurance Marketplace.

ACA premium tax credit income limits — 400% FPL

Premium tax credits help reduce monthly premiums for Marketplace plans. You may qualify if your income is between 100% and 400% FPL (and in some cases above 400% FPL).

How to apply for Marketplace coverage

• Visit Healthcare.gov during Open Enrollment (typically November–January)
• Call the Marketplace at 1-800-318-2596
• Get in-person help from a Navigator or Certified Application Counselor at Healthcare.gov
• Special Enrollment Periods apply within 60 days of qualifying life events (job loss, marriage, new child, etc.)

Helpful links