Pennsylvania calls its Medicaid program Medical Assistance (MA) — and it operates one of the most structured managed care systems in the country through HealthChoices. Every Medicaid recipient is enrolled in a HealthChoices managed care organization (MCO) that coordinates their care, with three distinct tracks: Physical HealthChoices for medical care, Behavioral HealthChoices for mental health and substance use, and Community HealthChoices (CHC) for long-term care.
The CHC Waiver is Pennsylvania’s flagship HCBS program — absorbing all prior aging waivers into a single statewide managed care structure. It is mandatory for dual eligibles (people receiving both Medicare and Medicaid) and anyone requiring nursing home-level care who wants to remain at home. It rolled out statewide in 2020 and now serves the full 67-county footprint of Pennsylvania.
Pennsylvania expanded Medicaid in 2015 under the ACA, covering adults 19–64 up to 138% FPL with no asset test. For seniors and people with disabilities seeking long-term care, stricter income and asset rules apply — including one of the lowest Personal Needs Allowances in the country at $45/month for nursing home residents.
This guide covers every Medical Assistance program, 2026 income limits, the CHC Waiver and PACE program, Pennsylvania’s Medically Needy spend-down, the 60-month look-back, and how to apply through COMPASS. For Medicaid income limits across all 50 states, see our Medicaid income limits by state guide.
Pennsylvania Medical Assistance Programs
Pennsylvania administers Medical Assistance through several distinct programs depending on your age, health needs, and care setting.
Physical HealthChoices covers standard medical care — doctor visits, prescriptions, hospitalizations, specialist services — for most MA recipients through an assigned managed care organization. When you enroll in Medical Assistance, you choose a Physical HealthChoices MCO or are assigned one.
Behavioral HealthChoices covers mental health treatment and drug and alcohol services through a separate MCO structure. Pennsylvania delivers behavioral health through a “carve-out” model — meaning mental health and substance use services are managed separately from physical health.
Community HealthChoices (CHC) is Pennsylvania’s mandatory managed care program for long-term services and supports. CHC covers seniors (65+) and physically disabled adults who require nursing home-level care and either: are dual-eligible for both Medicare and Medicaid, or are receiving long-term services through the former Aging or Independence waivers. CHC delivers personal care assistance, home modifications, meal delivery, adult day services, emergency response systems, and nursing facility care — through an individualized care plan.
Institutional / Nursing Home Medicaid covers care in nursing facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). This is an entitlement — anyone who meets the financial and functional criteria cannot be denied due to enrollment caps.
Regular Medicaid (Aged, Blind, and Disabled — ABD) covers low-income elderly, blind, or disabled Pennsylvanians who do not require nursing home-level care. Lower income and asset thresholds than long-term care programs.
CHIP (Children’s Health Insurance Program) covers children up to age 19 in households with incomes above Medicaid limits but still low, through Pennsylvania’s Children’s Health Insurance Program. Children through 300% FPL qualify. A sliding-scale premium applies for households between 235% and 300% FPL ($15–$60 per child per month).
Medicaid for Pregnant Women (Healthy Beginnings) covers pregnant women up to 300% FPL with no asset test. Coverage extends 12 months postpartum. Presumptive eligibility is available — meaning a pregnant woman can begin receiving prenatal care coverage on the day she applies, based on self-attestation of income, before the formal eligibility determination is complete.
ACA Expansion Adults (19–64) covers adults without dependent children up to 138% FPL. Pennsylvania expanded in 2015 — a year after the ACA expansion first became available. No asset test applies.
PACE (Program of All-Inclusive Care for the Elderly) combines Medicare and Medicaid benefits into a single coordinated care package for dual-eligible seniors aged 55+. PACE covers medical care, dental, vision, prescriptions, transportation, and personal care services — often including services not covered by either Medicare or Medicaid alone. A Medicaid eligibility determination is required to access PACE services in Pennsylvania.
Money Follows the Person helps Medicaid beneficiaries transition from a nursing facility back to home or community living. If you or a family member is currently in a nursing home but wants to return home, Money Follows the Person can fund the transition and ongoing supports. Contact the Pennsylvania Office of Long-Term Living (OLTL) at 1-800-757-5042 for details.
Pennsylvania Medicaid Income Limits — 2026
All amounts are monthly gross income. The Federal Benefit Rate (FBR) referenced below is $967/month for 2026.
| Program | Single Applicant | Married (Both Applying) |
|---|---|---|
| Nursing Home / CHC Waiver | $2,901/mo (300% FBR) | $5,802/mo |
| Regular Medicaid (ABD) | $967/mo (100% FBR) | $1,450/mo |
| ACA Expansion Adults (19–64) | $1,799/mo (138% FPL) | $2,432/mo |
| Children / CHIP | Up to $3,913/mo (300% FPL) | — |
| Pregnant Women (Healthy Beginnings) | Up to $3,913/mo (300% FPL) | — |
| Medically Needy (spend-down) | $425/mo | $442/mo |
Key Notes on Pennsylvania’s Income Rules
Pennsylvania’s $45/month Personal Needs Allowance is one of the lowest in the country. When a nursing home resident’s income exceeds the $2,901 threshold, the excess goes toward the cost of care — but the resident keeps a protected $45/month for personal expenses (toiletries, clothing, phone). Many states protect $60–$200 or more. If your loved one enters a Pennsylvania nursing facility on Medical Assistance, this is the discretionary income they retain.
Income above $2,901 for CHC/Nursing Home: Excess must be paid toward care costs, after protecting: the $45/month Personal Needs Allowance, Medicare premium payments, and potentially a Needs Allowance for a non-applicant spouse. A Qualified Income Trust (QIT) can redirect the excess to restore eligibility.
Community Spouse Allowance: When one spouse enters a nursing facility or CHC, the community spouse may keep income up to $3,948/month as a Minimum Monthly Maintenance Needs Allowance (MMMNA) — if their housing and utility costs exceed $793.13/month (effective July 1, 2025 – June 30, 2026).
CHIP Premiums: Pennsylvania charges sliding-scale premiums for CHIP once household income exceeds 235% FPL. Children from 235% to 300% FPL: $15–$60 per child per month. CHIP below 235% FPL: generally free. Check with Pennsylvania CHIP at 1-800-986-KIDS (5437) for current premium schedules.
Pregnant Women — Presumptive Eligibility: Coverage for prenatal services begins on the day of application via self-attestation. Formal verification follows. This eliminates the gap between application and first prenatal visit.
Federal Poverty Level Reference — 2026
| Household Size | 100% FPL | 138% FPL (ACA Adults) | 300% FPL (CHIP/Pregnant) |
|---|---|---|---|
| 1 | $1,304/mo | $1,799/mo | $3,913/mo |
| 2 | $1,762/mo | $2,432/mo | $5,287/mo |
| 3 | $2,221/mo | $3,064/mo | $6,662/mo |
| 4 | $2,679/mo | $3,697/mo | $8,037/mo |
Use the FPL Calculator to find the threshold for your exact household size.
Asset Rules for Pennsylvania Medical Assistance
No asset test applies to ACA expansion adults, children, pregnant women, or most CHIP enrollees. Asset limits apply to long-term care programs (CHC Waiver and Nursing Home) and ABD Regular Medicaid.
| Situation | Countable Asset Limit |
|---|---|
| Single applicant (LTC) | $2,000 |
| Married, both applying (LTC) | $3,000 |
| Married, one applying — applicant | $2,000 |
| Married, one applying — community spouse | Up to $157,920 (CSRA) |
| ABD Regular Medicaid (single) | $2,000 |
| ABD Regular Medicaid (couple) | $3,000 |
Home equity limit: The primary home is exempt while the applicant or spouse resides there or intends to return. Pennsylvania’s home equity cap is $730,000.
Exempt (Non-Countable) Assets
- Primary home (within the $730,000 cap)
- One vehicle
- Household goods and personal effects
- Pre-paid burial reserves (up to $1,500)
- Irrevocable Funeral Trusts (IFTs)
- Medicaid Compliant Annuities
- Life insurance with face value $1,500 or less
Pennsylvania’s Medically Needy Program
Pennsylvania operates a Medically Needy (spend-down) program for people whose income exceeds regular Medicaid limits but who have high medical expenses.
How it works: If your income exceeds the standard ABD limit but falls to $425/month (single) or $442/month (couple) after paying qualifying medical bills, you can qualify for Medicaid for the remainder of that month. The spend-down period in Pennsylvania is 1 month — one of the shortest in the country. This means medical bills must bring income below the Medically Needy Income Limit (MNIL) within a single calendar month to restore eligibility for that month.
The asset limit for the Medically Needy program is $2,400 (single) or $3,200 (couple).
This is especially relevant for seniors with Social Security income slightly above the $967 ABD limit who incur regular medical expenses. For Pennsylvanians who can’t qualify for regular ABD Medicaid due to income, the Medically Needy pathway may restore coverage month by month.
Pennsylvania’s 60-Month Medicaid Look-Back Period
Pennsylvania enforces a 60-month (5-year) look-back for Nursing Home Medicaid and the CHC Waiver. No look-back applies to ABD Regular Medicaid, ACA expansion, or Medically Needy.
Pennsylvania uses a daily divisor to calculate penalty periods. The value of transferred assets is divided by the average daily cost of nursing home care in Pennsylvania to determine the number of days of ineligibility — not months, which can result in penalty periods that don’t align neatly with calendar months.
What triggers a penalty: Any transfer of assets below fair market value within the 5-year look-back window — gifts to family members, below-market property sales, or certain trust transfers. The penalty period begins when you meet all other eligibility criteria, not at the time of the transfer.
Example: If you gave $20,000 to a family member in 2026 and applied for Medical Assistance 2 years later, and the average daily nursing home cost in Pennsylvania is $420/day, the penalty would be approximately 47.5 days of ineligibility beginning at the point you otherwise qualify.
Even small gifts compound. A $5,000 gift triggers an 11-day penalty. Multiple small transfers to different family members over several years can add up to significant penalty windows.
Transfers exempt from penalty:
- Transfers to a spouse
- Transfers to a blind or disabled child
- Transfers of the home to a caregiver child who lived in the home for at least 2 years before institutionalization and whose care delayed the need for nursing home placement
- Transfers to a sibling with an equity interest in the home who lived there at least 1 year before institutionalization
Consult a Certified Medicaid Planner before any asset transfer if long-term care Medicaid may be needed within 5 years.
Medical/Functional Requirements for Long-Term Care
To qualify for Nursing Home Medicaid or the CHC Waiver, applicants must demonstrate a Nursing Facility Level of Care (NFLOC) through documented limitations in:
- ADLs (Activities of Daily Living): Mobility, bathing, dressing, eating, toileting
- IADLs (Instrumental ADLs): Cooking, shopping, managing finances, medication management
- Cognitive/behavioral issues: Alzheimer’s, dementia, or other cognitive conditions — though diagnosis alone is not sufficient; functional limitations must be documented
For ABD Regular Medicaid, proof of disability or blindness per SSA criteria is required — NFLOC is not.
Medicaid Estate Recovery in Pennsylvania
Pennsylvania’s Medicaid Estate Recovery Program seeks reimbursement from a beneficiary’s estate after death for long-term care costs paid by Medical Assistance. Recovery applies to individuals aged 55 or older who received nursing facility services, CHC Waiver services, or related hospital and prescription drug costs.
Estate recovery primarily targets the primary home if not protected through a surviving spouse, qualifying disabled child, or caregiver child exemption. Proactive planning with a Certified Medicaid Planner well before a care need arises is the most effective protection.
Options If You Exceed the Limits
Qualified Income Trusts (QITs): If your income exceeds $2,901/month, a QIT (Miller Trust) redirects excess into an irrevocable trust, restoring long-term care eligibility while protecting the $45/month Personal Needs Allowance, Medicare premiums, and spousal income allowance. Pennsylvania Medicaid must be named as the trust beneficiary.
Irrevocable Funeral Trusts (IFTs): Pre-paid burial and funeral expenses in an irrevocable trust are exempt — a legitimate way to reduce countable assets while making practical plans.
Spend Down: Convert countable assets into exempt ones — home repairs, a vehicle, paying off debt, purchasing medically necessary equipment. Not all spend-down strategies avoid look-back scrutiny — consult a planner.
Medically Needy Program: If your income is above $967 but you have significant monthly medical expenses, you may qualify month-by-month through the spend-down process described above.
Medicaid Compliant Annuities: Convert excess assets into an income stream, reducing countable assets while directing income toward care costs.
Federal Policy Changes Coming to Pennsylvania Medical Assistance
Work Requirements (January 2027): Will apply to ACA expansion adults 19–64 who are not seniors, disabled, pregnant, or otherwise exempt. The One Big Beautiful Bill establishes 80 hours/month of work, volunteering, or job training as a condition. For context on how these requirements work, see our guide on SNAP work requirements — the Medicaid version follows similar logic. Full policy breakdown: Big Beautiful Bill SNAP and Medicaid changes.
Reduced Retroactive Coverage (January 2027): Medicaid will cover only 2 months prior to application (down from 90 days). Delayed applications will result in greater out-of-pocket medical expenses for the uncovered period.
More Frequent Renewals (December 2026): Renewals shift from annual to every 6 months for expansion adults. Missing a deadline risks a coverage gap. Pennsylvania’s COMPASS portal allows online renewal — use it proactively.
New Cost-Sharing (October 2028): Non-exempt enrollees may face up to $35 per specialist visit or procedure. Primary care and preventive services remain free. Nursing facility residents, children, pregnant women, and seniors are exempt.
Pennsylvania Medical Assistance and SNAP: The ACCESS Card Connection
Pennsylvania uses a single branded card — the Pennsylvania ACCESS Card — for both SNAP food benefits and Medical Assistance cash or support payments. This means your Medical Assistance enrollment is directly connected to Pennsylvania’s integrated benefits system.
Many Pennsylvania households qualify for both programs simultaneously:
- Pennsylvania SNAP uses 200% FPL Broad-Based Categorical Eligibility — if your household qualifies for MA, you very likely qualify for SNAP as well
- SNAP enrollment auto-qualifies most children for WIC
- Seniors receiving Medical Assistance often qualify for SNAP too — see can seniors on Social Security get food stamps?
The COMPASS portal applies for both programs simultaneously. Useful PA-specific links:
EBT card security: Pennsylvania now offers a card lock feature through the ConnectEBT app — allowing you to freeze your ACCESS Card between shopping trips to prevent unauthorized use. Use it. Pennsylvania has experienced significant EBT card skimming, with over $10 million in benefits stolen in a recent 12-month period. See how to lock your EBT card for setup instructions.
How to Apply for Pennsylvania Medical Assistance
Online (Recommended): Apply through COMPASS at compass.state.pa.us. COMPASS is Pennsylvania’s integrated online benefits portal — a single application covers Medical Assistance, SNAP, CHIP, and other DHS programs simultaneously. The portal is available 24/7, supports multiple languages, allows document uploads, and routes your application to your County Assistance Office automatically.
By Phone: Call the DHS Consumer Service Center at 1-866-550-4355 for Medical Assistance and CHIP applications. For general DHS assistance: 1-877-395-8930.
In Person or By Mail: Visit your nearest County Assistance Office — Pennsylvania has at least one CAO in each of its 67 counties. Download a paper application from dhs.pa.gov and return it by mail or in person. Find your nearest CAO at the DHS county locator.
Long-Term Care / CHC Waiver: Contact the Pennsylvania Office of Long-Term Living at 1-800-757-5042 or call the CHC participant hotline at 1-833-735-4416. An NFLOC assessment must be completed before CHC or Nursing Home Medicaid approval.
If coverage is lost: Pennsylvanians who lose Medical Assistance may qualify for subsidized coverage through Pennie™ — Pennsylvania’s official health insurance marketplace. Open enrollment runs November through January each year; special enrollment periods are available for qualifying life events. Visit pennie.com to compare plans.
For the full step-by-step application process, see: how to apply for Medicaid in Pennsylvania.
Documents You’ll Need
- Pennsylvania residency proof (utility bill, lease, or official mail)
- U.S. citizenship or qualifying immigration status documentation
- Income proof: pay stubs, SSA award letters, pension statements
- SSNs for all household members
- For LTC/ABD: bank statements, property records, 60 months of financial history
- For disability: SSA disability documentation or physician letter
- For pregnancy: physician verification (or self-attestation for presumptive eligibility)
Processing Times
- Standard applications: Up to 45 days
- Disability-based applications: Up to 90 days
- Children and pregnant women: Expedited processing within 45 days; presumptive eligibility for pregnant women takes effect on the day of application
Track your application status using the Track My Benefits tool on COMPASS at mycompass.pa.gov.
Frequently Asked Questions
What is Pennsylvania Medical Assistance?
Medical Assistance (MA) is Pennsylvania’s name for Medicaid — the federal-state health coverage program for low-income Pennsylvanians. It is administered by the Pennsylvania Department of Human Services (DHS) through County Assistance Offices across all 67 Pennsylvania counties. In 2026, Medical Assistance serves over 3.5 million Pennsylvanians. Coverage is delivered through the HealthChoices managed care system.
What are the 2026 Pennsylvania Medicaid income limits?
For Nursing Home/CHC Waiver: $2,901/month (single), $5,802/month (couple). For Regular Medicaid (ABD): $967/month (single), $1,450/month (couple). For ACA expansion adults: $1,799/month (single). For children/CHIP and pregnant women: up to $3,913/month (300% FPL). Medically Needy spend-down threshold: $425/month (single). See the full table above, or compare to other states’ income limits.
What is the Community HealthChoices (CHC) Waiver?
The CHC Waiver is Pennsylvania’s mandatory long-term services and supports program for adults 21+ who are dual-eligible (Medicare + Medicaid) or require nursing home-level care. It delivers personal care assistance, home modifications, meal delivery, adult day services, and nursing facility care through managed care organizations. CHC is statewide and replaced all prior aging and independence waivers. Contact the CHC participant hotline at 1-833-735-4416.
What is the Personal Needs Allowance in Pennsylvania?
$45/month — one of the lowest in the country. Nursing home residents on Medical Assistance keep $45/month for personal discretionary spending (toiletries, clothing, phone calls) after their remaining income goes toward the cost of care. HCBS/CHC Waiver participants are protected by a higher allowance.
What is the 60-month look-back period in Pennsylvania?
Pennsylvania reviews all asset transfers within the 5 years before a Nursing Home or CHC Waiver application. Transfers below fair market value trigger a penalty period calculated using a daily divisor — dividing the transferred amount by the average daily nursing home cost to determine days of ineligibility. The penalty begins when you otherwise qualify for Medicaid, not when the transfer occurred. No look-back applies to ABD Regular Medicaid or ACA expansion adults.
What is Pennsylvania’s Medically Needy Program?
The Medically Needy Program allows people with income above regular ABD Medicaid limits to qualify by spending down to $425/month (single) through qualifying medical expenses within a single calendar month.
It’s a 1-month spend-down period — one of the shortest in the country. Asset limit: $2,400 (single). Helpful for seniors with Social Security income slightly over $967/month who incur regular medical costs.
What is Pennie™?
Pennie™ is Pennsylvania’s official health and dental insurance marketplace — where Pennsylvanians who don’t qualify for Medical Assistance can shop for subsidized ACA coverage. If you lose Medical Assistance or earn too much to qualify, Pennie is the next step. Open enrollment: November through January. Special enrollment available for qualifying life events. Visit pennie.com.
Can I get both Medical Assistance and SNAP in Pennsylvania?
Yes — many Pennsylvania households qualify for both simultaneously through the same COMPASS portal application. Pennsylvania’s SNAP program uses 200% FPL BBCE, so if your household qualifies for Medical Assistance, SNAP qualification is likely. SNAP enrollment also auto-qualifies most children for WIC. See Pennsylvania SNAP benefits.
How do I apply for Pennsylvania Medical Assistance?
Apply online at compass.state.pa.us (covers MA, SNAP, CHIP, and more in one application), by phone at 1-866-550-4355, in person at your county’s County Assistance Office, or by mail using a form from dhs.pa.gov. For CHC Waiver / long-term care: call OLTL at 1-800-757-5042. Full guide: how to apply for Medicaid in Pennsylvania.
Last updated: 2026 | Sources: Pennsylvania Department of Human Services (DHS), Pennsylvania Office of Long-Term Living (OLTL), USDA FPL guidelines, CMS.gov. Verify current figures at compass.state.pa.us or by calling DHS at 1-877-395-8930. This guide is for informational purposes only — eligibility is determined by the Pennsylvania Department of Human Services.