Pennsylvania Medicaid Eligibility and Income Limits (2026)

Pennsylvania Medicaid income limits for long-term care in 2026 start at $2,982 a month for a single applicant, and the asset limit is either $2,400 or $8,000 depending on that same income. Pennsylvania does not call the program "Medicaid." It calls it Medical Assistance, a name that traces to the 1968 Public Welfare Code and still appears on every form, denial letter, and county-office sign. This guide is the eligibility and income reference for the family member, professional caregiver, or attorney working out whether a senior qualifies for nursing-facility or home-based Medical Assistance, with the actual 2026 figures and the rules behind them.

In This Guide

• Two Kinds of Pennsylvania Medicaid Eligibility
• The 2026 Pennsylvania Medicaid Income Limits
• Pennsylvania's Two-Tier Asset Limit
• If Your Income Is Over the Pennsylvania Medicaid Income Limit
• Spousal Protections When One Spouse Enters Care
• The Home and the 5-Year Lookback
• How to Apply
• Frequently Asked Questions
• Learn More

Two Kinds of Pennsylvania Medicaid Eligibility

Pennsylvania Medical Assistance has two financial gates, and which one applies depends on who is asking.

For working-age adults, parents, and children, eligibility runs on Modified Adjusted Gross Income (MAGI) measured against the federal poverty level. Pennsylvania is one of the 41 states (counting the District of Columbia) that adopted the Affordable Care Act Medicaid expansion, so adults qualify up to 138% of the federal poverty level under Medicaid.6 The 2026 federal poverty guideline is $15,960 a year for one person, so 138% works out to roughly $1,836 a month for a single adult.7 Pregnant women and children have their own, higher MAGI bands.

For seniors and people with disabilities seeking long-term care (nursing-facility care, the Community HealthChoices waiver, or LIFE/PACE), eligibility runs on a different, non-MAGI framework built around income limits, an asset test, and a 5-year lookback. This is the framework most families researching Pennsylvania Medicaid income limits actually need, and it is the focus of the rest of this guide.

The distinction matters because the numbers are different. A working-age adult qualifies based on a percentage of the poverty level; a senior applying for nursing-home coverage is measured against the Special Income Limit and a two-tier asset test described below.

The 2026 Pennsylvania Medicaid Income Limits

The figures below govern eligibility for nursing-facility Medical Assistance, the Community HealthChoices (CHC) waiver, and the LIFE program. The financial gate is the same across all three settings: the income limit, asset limit, and lookback do not change based on which long-term-care setting an applicant uses.1

The single most important figure for most families is the $2,982/month income limit, the Special Income Limit, equal to 300% of the 2026 SSI Federal Benefit Rate of $994.1,8 For a married couple where both spouses apply, the $2,982 limit applies to each spouse.8

Pennsylvania's Two-Tier Asset Limit

Most states use a single fixed asset limit for long-term-care Medicaid. Pennsylvania uses two, and which one applies depends on the applicant's gross monthly income.1

Tier One: $8,000

If the applicant's gross monthly income is at or below the $2,982 Special Income Limit, the countable asset limit works out to $8,000. That is the $2,000 resource limit codified at 55 Pa. Code Chapter 178 Appendix A plus a $6,000 Pennsylvania resource disregard that most other states do not provide. A low-income Pennsylvanian can therefore hold up to $8,000 in countable resources, such as modest savings or a burial reserve, without disqualifying.1 One practical note: DHS publishes the two pieces separately, as "$2,000 with an additional $6,000 resource disregard," so do not expect to find a single $8,000 figure printed on a DHS chart.1

Tier Two: $2,400

If the applicant's gross monthly income exceeds $2,982, the $6,000 disregard is lost and the asset limit drops to $2,400.1 The practical consequence: a small change in income can move an applicant from the $8,000 limit to the $2,400 limit, a $5,600 swing in how much they may keep. This is the most common mistake families make in Pennsylvania, assuming $2,400 is always the asset limit when it is $8,000 for most low-income applicants.

Pennsylvania's Medically Needy (MNO-MA) category, the spend-down pathway covered below, uses a separate asset limit of $2,400 for one person and $3,200 for two under 55 Pa. Code Chapter 178.5

If Your Income Is Over the Pennsylvania Medicaid Income Limit

Pennsylvania is a medically-needy state, which gives over-income applicants a pathway that pure income-cap states do not. Under 55 Pa. Code 181.14, an aged, blind, or disabled applicant whose countable income exceeds the categorical limit can still qualify by incurring medical expenses, computed over a six-month (semi-annual) budget period.5 Six months is also the federal maximum: 42 CFR 435.831(a) requires budget periods of not more than six months.5

The number you are spending down to is $2,550. For the medically-needy-only (MNO) categories, Pennsylvania's income limit is $2,550 in net income for the six-month period, not per month.1 Once submitted medical bills bring net income for the cycle down to that limit, Medical Assistance eligibility is established for the remainder of the cycle. The MNO asset limit is a separate and tighter $2,400 for one person.5

For an institutional applicant, the spend-down math usually works on its own, and DHS makes that explicit: where income exceeds 300% of the federal benefit rate, the anticipated cost of six months of long-term-care facility services is an allowable medical-expense deduction against monthly income.1 Nursing-facility bills at Pennsylvania's average private-pay rate of $12,811.50 a month clear a $2,550 semi-annual limit many times over.4 That is why a Miller Trust (Qualified Income Trust) is not required in Pennsylvania the way it is in pure income-cap states: the spend-down, not a trust, is the route Pennsylvania's own regulations lay out for an over-income applicant.5

If you are helping a Pennsylvania applicant whose income is above $2,982/month, the practical takeaway is that the medically-needy spend-down is the pathway to work through, and for a nursing-facility applicant it generally clears on its own.1 Because the exact arithmetic depends on that applicant's own income and medical bills, run the six-month numbers with the County Assistance Office or a Pennsylvania elder-law attorney before relying on the result.

Spousal Protections When One Spouse Enters Care

When one spouse enters a nursing facility and the other remains in the community, federal spousal-impoverishment rules let the community spouse keep a share of the couple's resources and income. Pennsylvania administers these using the federal minimum and maximum standards, not a single flat allowance.

The Community Spouse Resource Allowance (CSRA) is the amount of countable resources the at-home spouse may keep. At the date of institutionalization, all countable resources are tallied (the resource snapshot), and the community spouse retains half, no less than $32,532 and no more than $162,660 for 2026.2 Pennsylvania uses form PA-1572 to lock the snapshot at the moment of institutionalization, so filing it promptly after admission is one of the most important early steps a family can take.

The maintenance needs allowance lets the community spouse receive income from the institutionalized spouse. For 2026, the maximum monthly maintenance needs allowance is $4,066.50 (effective January 1, 2026), built up from a base minimum of $2,705.00 (effective July 1, 2026).2 When the institutionalized spouse's income is needed to bring the community spouse up to this allowance, that income flows to the community spouse before any of it is counted toward the cost of care.

Pennsylvania's full spousal-impoverishment mechanics, including the exact maintenance-needs calculation, are covered in the dedicated guide linked below.

The Home and the 5-Year Lookback

Home equity. For 2026 the Medicaid home equity limit is the federal minimum of $752,000 (up from $730,000 in 2025) unless the state elects a higher amount, up to a maximum of $1,130,000.3 An applicant whose home equity is at or below the standard their state applies is not disqualified on equity grounds.

The exception matters more than the number for most families. Under 42 U.S.C. 1396p(f)(2), the equity cap does not apply at all when the applicant's spouse, a child under 21, or a blind or permanently and totally disabled child of any age is lawfully residing in the home, and the home is then exempt as a resource without regard to equity.3 The cap therefore binds only a higher-value home occupied by a sole institutionalized applicant with no such relative living there.

The lookback. When someone applies for long-term-care Medical Assistance, Pennsylvania reviews asset transfers made in the previous 60 months (5 years), the federal standard under 42 USC 1396p(c).3 A transfer for less than fair market value during that window triggers a transfer penalty, a period during which Medical Assistance will not pay for care.3

The divisor. Pennsylvania computes the penalty using a daily divisor of $421.20 for 2026, recalculated each year from the average daily private-pay nursing-home cost in the Commonwealth.4 Most states use a monthly divisor and round to whole months; Pennsylvania uses a daily divisor and computes penalties to fractional days.4 The penalty period begins on the later of the transfer date or the date the applicant is otherwise eligible and receiving institutional-level care, not the date of the transfer itself.3 Certain transfers are exempt, including transfers to a spouse and transfers of the home to a qualifying caregiver child. The full lookback, penalty, and exempt-transfer mechanics are covered in the dedicated penalty-divisor guide linked below.

How to Apply

You can apply for Pennsylvania Medical Assistance three ways: online, in person at your County Assistance Office, or by phone.

The main intake form is the PA-600, the Pennsylvania Application for Benefits; institutional applicants also file the PA-600 LTC supplement, and married couples file the PA-1572 resource-assessment form to lock the Community Spouse Resource Allowance snapshot.2

How long a decision may take. Federal rules cap the wait rather than guarantee a date: 42 CFR 435.912(c)(3) allows the agency no more than 45 days to decide for most applicants and no more than 90 days for applicants who apply for Medicaid on the basis of disability, apart from unusual circumstances such as a delay caused by the applicant or an examining physician.9 Those are ceilings on the agency, not a promise of a faster answer. The longer window turns on the basis you applied under, not on whether a disability determination happens to arise in your case, so a senior applying on the basis of age falls under the 45-day ceiling even when the file involves medical records or a level-of-care review.9

Retroactive coverage, and a change coming in 2027. Federal law requires coverage of services furnished in or after the third month before the month of application, if the applicant would have been eligible when those services were furnished.10 That three-month window is narrowing: for applications filed on or after January 1, 2027, section 71112 of Public Law 119-21 shortens it to two months before the application month for most enrollees, and to one month for adults in the ACA expansion group.10 A family sitting on unpaid nursing-facility bills has a concrete reason to file before the end of 2026 rather than early in 2027.

If the County Assistance Office denies, reduces, or terminates Medical Assistance, the applicant has the right to a fair hearing decided by the Pennsylvania Bureau of Hearings and Appeals. The appeal must be filed in writing with the DHS office that took the action, normally the County Assistance Office, which forwards it to the Bureau.11

The deadline under 55 Pa. Code 275.3(b)(1) is 30 days from the date of the written notice, a state operating window well inside the 90-day ceiling federal rules allow at 42 CFR 431.221(d). Two extensions matter if that 30 days looks blown: the window is 60 days where no written notice was required or the agency simply failed to act, and runs up to 6 months where the county never sent the notice of the action and of the appeal right that it was required to send.11 Do not assume a late appeal is dead without checking which window applies.

One more timing point worth acting on: if the appeal is filed within the advance-notice period, before the action takes effect, assistance continues pending the hearing decision unless the recipient waives continuation.11

Where to Get Help

For complex cases, including spend-down planning, spousal-resource disputes, lookback questions, or a denial appeal, consult a Pennsylvania elder-law attorney. The Pennsylvania Bar Association's Elder Law Section maintains a referral service.

Learn More

Find personalized help understanding Pennsylvania Medicaid eligibility at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.