Medicaid Pennsylvania: Eligibility, Application & Benefits Guide

As of 2026, over 3.5 million Pennsylvanians receive coverage from Pennsylvania Medicaid (also known as Medical Assistance [MA]) administered as a system of programs by the Pennsylvania Department of Human Services (DHS). The Affordable Care Act (ACA) expanded Medicaid to include adults 19-64 who earn no more than 138% of the Federal Poverty Level (FPL) on January 1, 2015. The strength of the LTSS system is what makes Pennsylvania different from most states. Instead of one managed care company for long-term care, Pennsylvania has four: Community HealthChoices (CHC) is the state's program for dual Medicare/Medicaid recipients and physically disabled adults; its version of PACE is called the LIFE program; its program for adults with developmental disabilities is called the OBRA Waiver; and its program for seniors who require home-based care is called the Aging Waiver Program. Income eligibility for adults to be eligible for the ACA expansion is about $1,836 per month (138% of FPL), and the income limit for long-term care Medicaid is $2,982 per month for a single applicant.

This guide provides information about the eligibility for Medical Assistance in Pennsylvania, programs, how to apply, and changes in 2026. This information is from the Pennsylvania Department of Human Services, the COMPASS portal and Pennsylvania elder law resources.

2026 Pennsylvania Medicaid eligibility by category

Medical Assistance eligibility is divided into multiple avenues in Pennsylvania by age, family status, and health requirements.

Under the ACA expansion, the income eligibility for adults ages 19-64 is 138% of the Federal Poverty Level (FPL) (about $1,836 per month for a single adult in 2026, $3,795 for a family of four). There is no requirement for expansion adults to complete an asset test. The childless adults excluded under pre-ACA rules are included in the expansion population.

All children ages 0-18 qualify at 215% FPL (220% FPL with the 5% income disregard included). Coverage starts at 215% FPL and extends until the baby is born and 12 months after delivery. The parent/caretaker pathway is for parents and/or caretaker relatives of dependent children, although the ACA pathway is generally more advantageous in Pennsylvania (due to state Medicaid expansion).

Seniors 65+ and disabled adults under the Regular Medicaid / Aged, Blind, and Disabled (ABD) pathway will have an income limit of $1,016.10 per month (the Federal Benefit Rate (FBR)). ABD applicants with assets over $2,000 as a single person or $3,000 as a couple will be subject to asset limits.

The $2,982/month income limit and $2,000 asset limit (or $8,000 limit if income is equal to or below limit) apply to long-term care Medicaid through Nursing Home Medicaid or Community HealthChoices waivers. The amount of resources for the Aging Waiver Program (home care) is $8,000.

CHIP (Children's Health Insurance Program) provides coverage to children up to 314% FPL (about $49,148/year for a single parent or $98,296 for a family of four in 2026) at low monthly premiums starting at 235% of FPL.

Read our pillar guide for the general information on how to qualify for Medicaid.

Pennsylvania's specialty long-term care programs

Pennsylvania has developed a more robust long-term services and supports infrastructure than most states. The information about the program that is right for you is just as important as income requirements.

Community HealthChoices (CHC) is the required managed care plan that is offered to dual Medicare/Medicaid beneficiaries and physically disabled adults. CHC is the former Department of Aging Waiver and serves the entire state. They receive nursing facility, home and community based service and behavioral health care through one of three Community HealthChoices managed care organizations.

The LIFE program (Living Independence for the Elderly) is Pennsylvania's version of PACE (Program of All-Inclusive Care for the Elderly). With a team of physicians, nurses, social workers, therapists and more, LIFE offers comprehensive Medicare and Medicaid plans. Most members are provided with thorough treatment through LIFE centers as well as home treatment.

The OBRA Waiver is for adults 18-59 with developmental physical disabilities and an optional self-direction option, in which family members are paid caregivers. This pathway is especially useful for families who wish to continue to provide care to loved ones instead of hiring out-of-home providers.

The Aging Waiver Program (Medical Assistance Community HealthChoices) is available to those who may need nursing facility services if they are able to live at home, and for whom the nursing home placement isn't necessary. The income limit ($2,982/month) and resource limit ($8,000) apply.

See our nursing home Medicaid guide and Medicaid spending guides to compare long term care Medicaid programs among states.

The Medically Needy Only (MNO-MA) program

The Medically Needy Only Medical Assistance (MNO-MA) program is an option for Pennsylvanians with high medical costs who are over the income limit for the ABD Medicaid program.

The 2026 MNIL is $425 per month for single individuals and $442 per month for couples (one of the lowest in the nation). The spend-down will be your monthly income minus your MNIL. For example, a single person with $2,000 monthly income has a $1,575 monthly spend-down requirement ($2,000 - $425 = $1,575).

Pennsylvania does a spend-down in 6 months. To keep Medicaid coverage, you must have certain medical costs of at least $1575 per 6-month period. Eligible costs are such as doctor visits, prescription drugs, hospital costs, medical equipment, Medicare premiums, Medicare Part D premiums, and other medical care expenses.

The asset limit for the MNO-MA is $2,400 per person and $3,200 per couple (this is higher than the standard asset limit of $2,000/$3,000).

Personal Needs Allowance and spousal protections

Pennsylvania's Personal Needs Allowance (PNA) for nursing home residents is among the lowest in the country at $45 per month. Most states protect $60-$200 or more. When a nursing home resident's income exceeds the $2,982 threshold, the excess goes toward the cost of care after protecting the $45 PNA, Medicare premium payments, and potentially a Needs Allowance for a non-applicant spouse.

For married couples where one spouse needs long-term care Medicaid, Pennsylvania protects the at-home spouse through spousal impoverishment rules. The 2026 Community Spouse Resource Allowance (CSRA) ranges from $32,532 minimum to $162,660 maximum. Pennsylvania uses a 50% rule, allowing the community spouse to retain half of the couple's combined countable resources up to the federal maximum.

The Minimum Monthly Maintenance Needs Allowance (MMMNA) in Pennsylvania has a 2026 minimum of $2,644 per month (effective July 1, 2025) and a maximum of $4,066.50 per month. If the community spouse's income falls below their state-calculated MMMNA, they can keep some of the applicant spouse's income.

Pennsylvania's home equity limit for nursing home Medicaid is $752,000 in 2026. Married couples can keep their residence regardless of value if the community spouse continues to live there.

For broader Medicaid planning strategies, see our planning guides.

The 5-year look-back and penalty period

Pennsylvania follows the federal 60-month look-back period for long-term care Medicaid. Any asset transfers or gifts made within the 60 months before applying are reviewed, and improper transfers (below fair market value) create penalty periods of Medicaid ineligibility.

Pennsylvania's 2026 penalty divisor is $421.20 per day ($12,811.50 per month), used to calculate the penalty period. For example, gifting $40,000 within the look-back period creates approximately 95 days of Medicaid ineligibility ($40,000 ÷ $421.20 = 95 days). A $100,000 gift creates approximately 237 days of ineligibility.

The look-back applies only to Nursing Home Medicaid and HCBS Medicaid Waivers. It does not apply to ABD Medicaid or MAGI Medicaid (expansion adults).

Several exceptions exist. Transfers between spouses are unlimited. The Caregiver Child Exception allows transferring the home to an adult child who lived in the home and provided care for at least two years that delayed nursing home placement. The Sibling Exception allows transfer to a sibling with equity interest who lived in the home for at least one year before institutionalization.

For comprehensive Medicaid planning attorney guidance, see our planning attorney guide.

How to apply for Pennsylvania Medical Assistance

Pennsylvania offers multiple application paths through the COMPASS portal and county offices.

The COMPASS portal at compass.state.pa.us is the primary online application system. Create an account, upload documents, and track application status in real time. The myCOMPASS PA mobile app allows document uploads directly from your phone.

By phone, call the Health Care Coverage Consumer Service Center at 1-866-550-4355.

In person, visit your local County Assistance Office (CAO). Pennsylvania has 67 county offices statewide, each handling Medical Assistance applications and questions.

For long-term care applications, the "Medical Assistance (Medicaid) Financial Eligibility Application for Long Term Care, Supports and Services" can be submitted to your local CAO. Area Agencies on Aging often provide application assistance.

Application processing typically takes 30 days for MAGI Medicaid categories and up to 90 days for ABD or long-term care applications requiring additional documentation.

For state comparisons, see our Medicaid California and Medicaid Illinois guides.

2026 changes affecting Pennsylvania Medicaid

Several federal and state policy changes take effect during 2026.

The One Big Beautiful Bill Act (OBBBA) implements work requirements for expansion adults starting December 2026, shifting from annual to every 6 months for renewals. Missing a deadline risks coverage gaps. The COMPASS portal allows online renewal proactively.

GLP-1 drugs (Wegovy, Zepbound) are no longer covered for weight loss alone as of January 2026. They remain covered for diabetes treatment with documented medical necessity.

Pennsylvania's federal poverty level adjustments increased thresholds by approximately 3% for 2026 compared to 2025.

Community HealthChoices continues expanding home-based waiver slots, allowing more Pennsylvanians to receive long-term care at home rather than in nursing facilities.