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What is Pennsylvania Medicaid Program?
Medicaid provides health coverage to millions of Americans, including children, pregnant women, parents, seniors and individuals with disabilities. In some states the program covers all low-income adults below a certain income level.
Note: Medicaid is sometimes referred to by state specific names. Regardless of the various names, the programs are still Medicaid and are governed by Federal Medicaid law and regulations.
Who is eligible for Pennsylvania Medicaid Program?
To be eligible for Pennsylvania Medicaid, you must be a resident of the state of Pennsylvania, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be one of the following:
- Pregnant, or
- Be responsible for a child 17 years of age or younger, or
- Have a disability or a family member in your household with a disability.
PA Medical Assistance Income Limits 2023
| Household Size* | Maximum Income Level (Per Year) |
|---|---|
| 1 | $19,392 |
| 2 | $26,228 |
| 3 | $33,064 |
| 4 | $39,900 |
| 5 | $46,737 |
| 6 | $53,573 |
| 7 | $60,409 |
| 8 | $67,245 |
*For households with more than eight people, add $6,836 per additional person. Always check with the appropriate managing agency to ensure the most accurate guidelines.
PA Medicaid Income Limits 2023 Family Size And Income Limits
The Pennsylvania Medical Assistance program uses a sliding scale to determine eligibility, taking into account the size of the household and the maximum allowable income for that household. The income limits for 2023 are as follows:
- Household Size of 1: For individuals living alone, the maximum income level to qualify for Medical Assistance in Pennsylvania is $19,392 per year.
- Household Size of 2: If you are a two-person household, such as a couple or a parent with one child, your combined annual income should not exceed $26,228 to be eligible for Medical Assistance.
- Household Size of 3: Families or households with three members must have a total annual income below $33,064 to qualify for Medical Assistance.
- Household Size of 4: A four-person household, which may consist of parents and two children, must have a combined annual income that does not exceed $39,900 to be eligible for Medical Assistance.
- Household Size of 5: Families with five members, including parents and three children, can qualify for Medical Assistance if their total annual income is below $46,737.
- Household Size of 6: For households with six members, such as larger families, the income limit for Medical Assistance eligibility is set at $53,573 per year.
- Household Size of 7: Seven-member households must have an annual income below $60,409 to qualify for Medical Assistance in Pennsylvania.
- Household Size of 8: The largest eligible household size is eight members, and their maximum allowable income for Medical Assistance is $67,245 per year.
It’s essential to note that these income limits are subject to change and may be adjusted periodically to account for economic factors and changes in the cost of living. Additionally, certain exemptions and deductions may apply, which can impact the final determination of eligibility.
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PA Medical Assistance Income Limits 2023
Medical Assistance General Eligibility Requirements : You must meet income, resources (in some cases), and other eligibility requirements in order to be eligible for Medical Assistance. Medical Assistance eligibility is grouped by:
- Modified Adjusted Gross Income (MAGI)
- Children aged 18 and under
- Pregnant women
- Parents and caretakers of children under 21
- Adults ages 19-64 with incomes at or below 133 percent of the Federal Income Poverty Guidelines (FPIG)
- Family planning services
- Non-MAGI
- Individuals ages 65 and older
- Individuals who are blind and/or disabled
- Medical Assistance for Workers with Disabilities (MAWD)
- Individuals receiving long-term care (LTC) or home and community-based services (HCBS)
PA Medical Assistance Income Guidelines 2023
Medical Assistance eligibility is determined using income and household size in comparison to income limits. Examples of income counted in determining eligibility include:
- Wages
- Interest
- Dividends
- Social Security
- Veterans’ Benefits (except for MAGI MA)
- Pensions
- Spouse’s income if living with him/her
Examples of income not counted when determining eligibility include:
- Temporary Assistance for Needy Families (TANF) benefits
- Supplemental Security Income (SSI)
- Supplemental Nutrition Assistance Program (SNAP) benefits
- Low Income Home Energy Assistance Program (LIHEAP) benefits
- Foster Care payments
- Certain housing or utility subsidies
- Weatherization Payments
- Child Support Payments (only for MAGI MA)
PA Medical Assistance Income Limits 2023
Some Medical Assistance eligibility groups have resource limits. The charts below provide specific details:
Non-Money Payment (NMP) PA Medical Assistance
| Non-MAGI |
| One Person = $2,000 |
| Two People = $3,000 |
Medically-Needy Only PA Medical Assistance
| Non-MAGI |
| One Person = $2,400 |
| Two People = $3,200 |
| Each Additional Person = $300 |
PA Medicare Buy-In Programs | PA Medical Assistance Income Limits 2023
| Healthy Horizons Cost Sharing, Specified Low-Income Medical AssistanceBeneficiary, Qualifying Individual Categories |
| One Person = $9,090 |
| Two Persons = $13,630 |
NOTE: There is no resource exclusion for pregnant women, children under 21 or families with children under 21 for Medicare Buy-In Programs.
PA Medical Assistance for Workers with Disabilities (MAWD)
| MAWD |
| Any Household Size = $10,000 |
Other Eligibility Requirements For PA Medical Assistance
- Identity — Identity can be verified by a driver’s license, state identification card or another piece of identification.
- Social Security Number (SSN) — A SSN must be provided for each person applying for Medical Assistance. County Assistance Office staff will help you apply for an SSN for anyone who does not have one.
- Residency — Medical Assistance is available to individuals who are residents of Pennsylvania if all other eligibility requirements are met. There is no requirement regarding the length of time that a person must live in Pennsylvania.
- Citizenship — Medical Assistance is available to United States citizens, refugees, and certain lawfully admitted non-citizens. Other non-citizens may be eligible for limited Medical Assistance benefits if an emergency medical condition exists. U.S. citizens, refugees and lawfully admitted non-citizens must submit documentation proving U.S. citizenship or lawful non-citizen status.
- Household Composition — County Assistance Office staff will determine who are mandatory or optional budget group members in the Medical Assistance application based upon household relationships and individual needs for Medical Assistance.
PA Medical Assistance for Children and Pregnant Women
Income Requirements for Medical Assistance for Children and Pregnant Women
| Household Size | Monthly Pregnant Women and Infants Under Age One (215 percent FPIG) | Monthly Children Age One to Age Five (157 percent FPIG) | Monthly Children Ages Six to Under Age 19 (133 percent FPIG) |
|---|---|---|---|
| 1 | $2,613 | $1,908 | $1,616 |
| 2 | $3,534 | $2,581 | $2,186 |
| 3 | $4,455 | $3,253 | $2,756 |
| 4 | $5,375 | $3,925 | $3,325 |
| 5 | $6,296 | $4,598 | $3,895 |
| 6 | $7,217 | $5,270 | $4,465 |
| 7 | $8,138 | $5,943 | $5,035 |
| 8 | $9,059 | $6,615 | $5,604 |
| Each Additional Person | $921 | $673 | $570 |
- Pregnant women and children up to age one: Family income may not exceed 215 percent of the FPIG — When determining which income eligibility limit applies to a pregnant woman, household size is increased by the number of unborn children. Example: If a woman verifies she is pregnant with twins, then she counts as three persons.
- Children ages one through five —Family income may not exceed 157 percent of the FPIG.
- Children ages six through 18 — Family income may not exceed 133 percent of the FPIG.
- No Resource requirements —Resources such as vehicles, property, and life insurance are not considered in determining eligibility for this program.
Medical Assistance (MA) provides coverage for:
- Pregnant women (coverage for pregnant women can begin as soon as your doctor or nurse informs you that you are pregnant).
- Children of low-income families through age 18.
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.
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How Can I Apply for MA?
- If you are pregnant, your doctor’s office, health clinic, or a qualified hospital may be able to complete a form providing you with temporary eligibility (presumptive eligibility) and assist you in completing an application.
- You may apply online using COMPASS. You can also use COMPASS to apply for other benefits such as the Supplemental Nutrition Assistance Program (SNAP) and Cash Assistance.
- You can also contact your local county assistance office for an application or you may download an application form (below) to send to your county assistance office. If you need help completing the application form and a friend or relative is unable to help you, trained county assistance office staff members can help you.
- Application for Health Care Coverage
- Solicitud de la cobertura medica
What are the Medical Benefits for Children and Pregnant Women?
- Provides health care coverage to underinsured or uninsured pregnant women and infants
- Full scope of medical services coverage
- Coverage for the pregnant woman eligible for and receiving Medical Assistance is continued for 60 days after the birth
- Proper prenatal care
- Early detection and treatment of health problems
- Helps in decreasing infant mortality
- Helps in decreasing low birth weight, which is tied to health problems later in life
PA Medical Assistance Benefits for Workers with Disabilities
For people with disabilities, finding a job or returning to work can be a challenge. For a long time, one of the biggest obstacles to working was health care coverage. Earning too much money meant risking losing health care benefits. However, there is an option: Medical Assistance for Workers with Disabilities (MAWD).
MAWD lets Pennsylvanians with disabilities take a fulfilling job, earn more money and still keep their full medical coverage. With MAWD you can keep Medical Assistance while you work, even if your earnings increase above the limits for other Medical Assistance programs. Now you do not have to choose between a job and your health.
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PA Medical Assistance Eligibility for Workers with Disabilities Eligibility
To be eligible for MAWD, you must:
- Be at least 16 years of age but less than 65
- Be employed and receiving compensation
- Have a disability that meets the Social Security Administration’s standardsOpens In A New Window
- Have countable income below 250 percent of the Federal Poverty Income GuidelinesOpens In A New Window
- Have $10,000 or less in countable resources (resident property and one automobile are not countable assets)
–Disabilities may include physical or developmental disabilities, mental health or intellectual disabilities.
–Contact your caseworker or local county assistance office(CAO) for more information. You can apply for benefits online in a quick, easy and secure way using COMPASS.
Monthly premium | PA Medical Assistance Income Limits 2023
Premium Vouchers are mailed monthly as long as you remain eligible for MAWD. There are two ways to pay your monthly premium, online and mail.
- Online: In most cases you can pay your monthly premium online using a credit card or Telechek. Follow the instructions on the MAWD Online Flyer or click on the make payment link above.
- Mail: Remit payment in the business reply envelope included with your monthly voucher.
Benefits may include:
- Doctor visits
- Durable medical equipment
- Prescription drugs
- Emergency care
- Mental health services
- Dental services
- Drug and alcohol treatment
- Hospital stays
- Rehabilitation services
- Hospice services
- Medical transportation services
Medical Assistance for Older People and People with Disabilities
Pennsylvania’s Medical Assistance (Medicaid) program provides health care benefits for older people (ages 65 and older), people with disabilities, or people who are blind. Information on this page describes general eligibility requirements and benefits.
Non-Money Payment (NMP) | PA Medical Assistance Income Limits 2023
| Number of People | NMP Categories Net Monthly Income Limit |
| 1 | $936.10 |
| 2 | $1,404.30 |
Medically Needy Only (MNO)| PA Medical Assistance Income Limits 2023
| Number of People | MNO Categories Net Monthly Income Limits | MNO Categories Net 6-Month Income Limits |
| 1 | $ 425 | $ 2,550 |
| 2 | $ 442 | $ 2,650 |
| 3 | $ 467 | $ 2,800 |
| 4 | $ 567 | $ 3,400 |
| 5 | $ 675 | $ 4,050 |
| 6 | $ 758 | $ 4,550 |
| 7 | $ 850 | $ 5,100 |
| 8 | $ 942 | $ 5,600 |
| Each Additional Person | $ 92 | $ 550 |
State Blind Pension
State-funded program dedicated to helping low-income individuals and families who meet visual and other eligibility requirements move to independence. View additional information on the State Blind Pension program.
Healthy Horizons | PA Medical Assistance Income Limits 2023
Eligible persons may be eligible to receive help to pay their Medicare premiums. The Medical Assistance program (also referred to as Medicaid) includes a coverage plan designed to help elderly individuals or individuals with disabilities who are eligible for Medicare to pay some or all of their Medicare premiums. Individuals must meet income and resource limits. Income limits are based on a percentage of the Federal Poverty Income Guidelines (FPIG), which are revised annually. Healthy Horizons includes the following:
Qualified Medicare Beneficiary (QMB) — Categorically Needy Program
Also known as Healthy Horizons in Pennsylvania, individuals who qualify for these benefits are eligible for Medical Assistance payments of their Medicare Part A and Part B premiums and payment of Medicare deductibles and coinsurance. They are also eligible for medical coverage through the Medical Assistance program. Income and resource limits are as follows:
| Number of People | 2023 Federal Poverty Level (FPIG) | Monthly Income Limit (FPIG + $20 Deductible = Limit | Resource Limit |
| 1 | 100 percent or less | $1,215 + $20 = $1,235 | $2,000 |
| 2 | 100 percent or less | $1,644 + $20 = $1,664 | $3,000 |
Qualified Medicare Beneficiary (QMB) — Medicare Cost-Sharing Program
Also known as Healthy Horizons-Medicare Cost-Sharing in Pennsylvania, individuals who qualify for these benefits are eligible for payment of their Medicare Part A and Part B premiums and payment of Medicare deductibles and coinsurance. Income and resource limits are as follows:
| Number of Persons | 2023 Federal Poverty Level (FPIG) | Monthly Income Limit (FPIG + $20 Deductible = Limit) | Resource Limit |
| 1 | 100 percent or less | $1,215 + $20 = $1,235 | $9,090 |
| 2 | 100 percent or less | $1,644 + $20 = $1,664 | $13,630 |
Specified Low-Income Medicare Beneficiary (SLMB) Program
Individuals who qualify for these benefits are eligible for payment of their Medicare Part B premium only. Income and resource limits are as follows:
| Number of People | 2023 Federal Poverty Level (FPIG) | Monthly Income Limit (FPIG + $20 Deductible = Limit) | Resource Limit |
| 1 | At least 100 percent but less than 120 percent | $1,215 + $20 = $1,235 Less than $1,458 + $20 = $1,478 | $9,090 |
| 2 | At least 100 percent but less than 120 percent | $1,644 + $20 = $1,664 Less than $1,972 + $20 = $1,992 | $13,630 |
Qualifying Individuals Group 1 (QI-1)
Individuals who qualify for these benefits are eligible for payment of their Medicare Part B premium only. Income and resource limits are as follows:
| Number of People | 2022 Federal Poverty Level (FPIG) | Monthly Income Limit (FPIG + $20 Deductible) | Resource Limit |
| 1 | At least 120 percent but less than 135 percent | $ 1,458 + $20 = $1,478 Less than $ 1,641 + $20 = $1,661 | $9,090 |
| 2 | At least 120 percent but less than 135 percent | $1,972 + $20 = $1,992 Less than $2,219 + $20 = $2,239 | $13,630 |
FAQ’s-PA Medical Assistance Income Limits 2023
Q: What are the maximum income limits for Pennsylvania Medical Assistance in 2023 for a household size of one?
Ans: The maximum income limit for a household size of one is $19,392 per year.
Q: Can a two-person household qualify for Pennsylvania Medical Assistance in 2023? If so, what is the maximum allowable income?
Ans: Yes, a two-person household can qualify for Pennsylvania Medical Assistance in 2023. The maximum allowable income for a two-person household is $26,228 per year.
Q: What is the income limit for a three-person household to be eligible for Pennsylvania Medical Assistance in 2023?
Ans: The income limit for a three-person household to be eligible for Pennsylvania Medical Assistance in 2023 is $33,064 per year.
Q: How much can a four-person household earn annually and still qualify for Pennsylvania Medical Assistance in 2023?
Ans: A four-person household can qualify for Pennsylvania Medical Assistance in 2023 if their total annual income does not exceed $39,900.
Q: What is the income threshold for a family of five to be eligible for Pennsylvania Medical Assistance in 2023?
Ans: Families with five members can qualify for Pennsylvania Medical Assistance in 2023 if their total annual income is below $46,737.
Q: For a household with six members, what is the maximum allowable income to be eligible for Pennsylvania Medical Assistance in 2023?
Ans: The income limit for a household with six members to qualify for Pennsylvania Medical Assistance in 2023 is $53,573 per year.
Q: Can a seven-member household qualify for Pennsylvania Medical Assistance in 2023, and if so, what is the maximum income allowed?
Ans: Yes, a seven-member household can qualify for Pennsylvania Medical Assistance in 2023 with an annual income below $60,409.
Q: What is the maximum allowable income for an eight-person household to be eligible for Pennsylvania Medical Assistance in 2023?
Ans: The income limit for an eight-person household to qualify for Pennsylvania Medical Assistance in 2023 is $67,245 per year.
Q: Are these income limits subject to change, and if so, how often are they updated?
Ans: Yes, these income limits are subject to change and may be adjusted periodically to account for economic factors and changes in the cost of living. It’s essential to stay updated with the latest information from the Pennsylvania Department of Human Services or the official Pennsylvania Medical Assistance website for any updates to the income limits.
Q: Are there any exemptions or deductions that can impact eligibility for Pennsylvania Medical Assistance?
Ans: Yes, certain exemptions and deductions may apply, which can impact the final determination of eligibility for Pennsylvania Medical Assistance. It’s advisable to consult with the Pennsylvania Department of Human Services or a qualified healthcare professional for more information on specific exemptions and deductions that may apply to your situation.
Conclusion: 2023 income and resource limits for medicaid and other health programs
Access to healthcare is a fundamental right, and the Pennsylvania Medical Assistance program plays a crucial role in ensuring that individuals and families with low incomes have the opportunity to receive necessary medical services. The income limits for 2023, based on household size, provide clear guidelines for determining eligibility for this essential program.
If you or your family fall within these income limits, you may be eligible for Pennsylvania Medical Assistance, helping you access the healthcare services you need to lead a healthy and productive life. To learn more about the program and apply for assistance, visit the official Pennsylvania Medical Assistance website or contact your local Department of Human Services office.