Medicaid General Eligibility | Department of Human Services | Commonwealth of Pennsylvania
Medicaid / ​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 age 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)
Income
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)
Income Limits
The income limits for specific eligibility groups can be found here:
Medical Assistance for Children and Pregnant Women
Reproductive Health
(Family Planning)
Medical Assistance Benefits for Workers with Disabilities
(MAWD)
Medical Assistance for Older People and People with Disabilities
Federal Poverty Income Guidelines (FPIG)
Resources
Medical Assistance eligibility for non-MAGI individuals is also determined using resource and household size in comparison to resource limits.
NOTE: Resource limits do not apply for:
MAGI MA eligibility groups
Pregnant women
Individuals with children (aged 20 and under) under their care and control
Children under the age of 21
For Medicare Buy-In programs and MAWD, resources are still counted even if a pregnant woman or child under age 21 is in the household.
Examples of
resources counted
in determining eligibility include:
Cash
Checking accounts
Savings accounts and certificates
Christmas or vacation clubs
Stocks and bonds
Some trust funds
Life insurance
Vehicles
Revocable burial funds
Non-resident property
Examples of
resources not counted
in determining eligibility include:
Your home
Revocable and irrevocable burial reserves subject to specified limits
Burial space and marker
One motor vehicle
Resource Limits
Some Medical Assistance eligibility groups have resource limits. The charts below provide specific details:
Non-Money Payment (NMP) Medical Assistance
Non-MAGI
One Person = $2,000
Two People = $3,000
Medically-Needy Only Medical Assistance
Non-MAGI
One Person = $2,400
Two People = $3,200
Each Additional Person = $300
Medicare Buy-In Programs
Healthy Horizons Cost Sharing, Specified Low-Income Medical Assistance
Beneficiary, Qualifying Individual Categories
One Person = $9,950
Two Persons = $14,910
NOTE: There is no resource exclusion for pregnant women, children under 21 or families with children under 21 for Medicare Buy-In Programs.
Medical Assistance for Workers with Disabilities (MAWD)
Any Household Size = $10,000
Other Eligibility Requirements
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.
Additional Information
Medical Assistance Eligibility Handbook
OIM Recent Operations Memoranda and Policy Clarifications