Pennsylvania's Medicaid income limits depend on which program you're looking at
Pennsylvania does not have a single income limit for Medicaid. Instead, the state runs several programs with different thresholds. The most common program for adults is Medicaid Expansion, which covers people earning up to 138% of the federal poverty level. For a single adult in 2024, that's roughly $1,876 per month; for a family of three, roughly $3,864 per month. Other programs—like those for children, pregnant people, seniors, or people with disabilities—have their own separate limits.
Income limits also change once per year, usually in January, when the federal poverty level is updated. The exact dollar amount you need to know depends on your household size and which program you might be covered under. Pennsylvania's Department of Human Services maintains the current limits on its website, and most local county assistance offices can tell you the current threshold for your situation in one phone call.
Key Takeaways
- Medicaid Expansion in Pennsylvania covers adults earning up to 138% of the federal poverty level, which is approximately $1,876 per month for one person.
- Children, pregnant people, seniors, and people with disabilities have different income limits—some higher, some lower—depending on the specific program.
- Income limits change every January when the federal poverty level updates, so the exact dollar amount varies year to year.
- Your county assistance office or the Pennsylvania Department of Human Services can confirm the current limit for your household size and program type.
How Pennsylvania calculates your monthly income for Medicaid
Pennsylvania counts gross monthly income—the money you earn before taxes or deductions. This includes wages from a job, self-employment income, Social Security, unemployment benefits, child support, and some types of pension or retirement income. It does not include food stamps, housing assistance, or certain one-time payments.
If you are self-employed, the state counts your net business income (revenue minus business expenses). If you receive income irregularly—say, seasonal work or freelance pay—Pennsylvania averages it over the past three months or the past year, depending on the program. If your income fluctuates month to month, report what you expect to earn over the next month when you apply.
For households with multiple earners, Pennsylvania adds all members' income together. A household is usually you, your spouse (if married), and any children under 19 living with you. Adult children, parents, or other relatives living in the home are not counted as household members for income purposes unless they are your spouse or dependent child.
Income limits for the most common Pennsylvania Medicaid programs
| Program | Who It Covers | Income Limit (% of Federal Poverty Level) |
|---|---|---|
| Medicaid Expansion | Adults ages 19–64 without dependent children | 138% of federal poverty level |
| Medicaid for Families and Children | Parents and children under 19 | Varies; typically 138% to 200% of federal poverty level |
| Medicaid for Pregnant People | Pregnant individuals and those up to 60 days postpartum | 196% of federal poverty level |
| Medicaid for Seniors and Disabled | People age 65+ or with disabilities | 100% of federal poverty level (with asset limits) |
The income limits shown above are the most common thresholds, but Pennsylvania also runs specialized programs for people who are blind, have specific disabilities, or live in long-term care facilities. Each has its own rules. If you fall into one of these categories, your county assistance office can tell you the exact limit that applies to you.
What happens if your income is above the limit
If your monthly income exceeds the limit for the program you're looking at, you will not be covered under that particular program. However, Pennsylvania has other options depending on your situation. If you are over the Medicaid Expansion limit but under 400% of the federal poverty level, you may be able to purchase coverage through the federal health insurance marketplace (Healthcare.gov) and receive a tax credit to lower your monthly premium.
If you are a senior or have a disability and your income is above 100% of the federal poverty level, you may still be covered under Medicaid for Aged, Blind, and Disabled (ABD) if you have limited assets. Asset limits are separate from income limits; you can have some savings and still may have access to. Your county assistance office can walk you through whether you meet both the income and asset requirements.
Some people's income fluctuates seasonally or month to month. If you expect your income to drop below the limit in the coming months, you can still apply. Pennsylvania will base your coverage on your expected income going forward, not your income in the past.
How to find your county's current income limits
The fastest way to get the exact current limit for your household is to call your county assistance office. Pennsylvania has 67 county offices, and each one has staff who can tell you the 2024 or 2025 limit in seconds. You can find your county office's phone number on the Pennsylvania Department of Human Services website by entering your county name.
You can also visit the state's website directly to view the income limit tables. These tables are updated every January and show the limit for each household size (one person, two people, three people, and so on) for each program. The tables are in PDF format and are organized by program name.
If you do not have internet access or prefer to speak with someone, calling 211 (a free helpline) will connect you to a local resource specialist who can tell you the current limit and help you find your county office. No personal information is required to ask this question.
What to bring when you apply
When you apply for Medicaid, you will need to show proof of your income. Bring recent pay stubs (usually the last 30 days), tax returns from the past year, or a letter from your employer stating your hourly rate and hours per week. If you receive Social Security, unemployment, or other benefits, bring the award letter or a recent statement showing the monthly amount.
If you are self-employed, bring your business tax return and a record of recent income (invoices, bank statements, or a profit-and-loss statement). If your income is irregular, bring documentation for the past three months so Pennsylvania can average it correctly.
You will also need proof of identity, proof of Pennsylvania residency, and proof of citizenship or immigration status. A driver's license, passport, or state ID card works for identity. A utility bill, lease, or mortgage statement works for residency. For citizenship, a birth certificate or passport is standard.
Frequently Asked Questions
Does Pennsylvania count child support or alimony as income for Medicaid?
Yes. Child support and alimony payments you receive are counted as income. If you pay child support or alimony, those payments are not deducted from your income—Pennsylvania counts your gross income before those payments leave your account.
What if I'm unemployed but getting unemployment benefits?
Unemployment benefits count as income. Pennsylvania will count the weekly or monthly amount you receive. If you are also looking for work and expect to earn wages soon, report your expected wages when you apply, and the state will base your coverage on the total expected income.
Do I lose Medicaid if my income goes above the limit after I'm covered?
Not immediately. Pennsylvania allows a grace period, usually one month, before your coverage ends. You should report the income change to your county assistance office as soon as it happens. Depending on the program and how much your income increased, you may still be covered for part of the month or may be able to transition to marketplace coverage with a tax credit.
Are there any deductions from my income before it's compared to the limit?
For most Medicaid programs in Pennsylvania, no. The state counts your gross income without deductions. However, for seniors and people with disabilities under the ABD program, there are some deductions allowed (such as medical expenses). Ask your county office whether deductions apply to your specific situation.
What if my household size changes during the year?
Report the change to your county assistance office right away. If a household member moves out or a new person moves in, your income limit may change because it is based on household size. Pennsylvania will recalculate your coverage based on the new household composition and total income.