Medicaid eligibility in Pennsylvania — income limits for 2025
The number
Pennsylvania Medical Assistance covers pregnant women up to 215% of the federal poverty line — $55,510 annual income for a family of three in 2025.
Income limits in dollars (2025)
| Category | % FPL | Household of 1 | Household of 3 | Household of 4 |
|---|---|---|---|---|
| Pregnant women | 215% | $32,380 | $55,510 | $67,080 |
| Children 0-5 | 215% | $32,380 | $55,510 | $67,080 |
| Children 6-18 | 215% | $32,380 | $55,510 | $67,080 |
| Parents / caretakers | 33% | $4,970 | $8,520 | $10,300 |
| Expansion adults (19-64) | 138% | $20,780 | $35,630 | $43,060 |
Who qualifies and how the income limits work
Pennsylvania Medical Assistance uses modified adjusted gross income (MAGI) rules to test eligibility. For 2025, the thresholds for a three-person household are: pregnant women up to 215% of the federal poverty line ($55,510), children 0-5 up to 215% ($55,510), children 6-18 up to 215% ($55,510), and parents / caretaker relatives with dependents up to 33% ($8,520).
Adults 19-64 who don't fit another category qualify under Medicaid expansion up to 138% of the federal poverty line — $35,630 for a family of three. The state adopted expansion in 2015, so there is no coverage gap between the parent ceiling and ACA marketplace subsidies.
Citizenship / immigration status: US citizens and most lawfully present immigrants (with a 5-year waiting period for most categories under PRWORA) qualify if they meet the income test. Pregnant women and children may qualify in narrower circumstances under the CHIPRA 2009 state option. Assets test: no assets / resources test for MAGI-category applicants; a test applies for long-term care and non-MAGI applicants.
Governor Tom Wolf rolled back Corbett-era Healthy PA work requirements in his first year (2015), fully implementing expansion. Act 117 of 2023 directed the Department of Human Services to pursue a Section 1915(i) State Plan Amendment to add doula services — implementation was expected in 2025.
For Black families
Expansion in Pennsylvania extended Medicaid to adults up to 138% of the federal poverty line regardless of parental status, removing one of the biggest barriers to coverage for Black adults in physically demanding hourly-wage work. Governor Tom Wolf rolled back Corbett-era Healthy PA work requirements in his first year (2015), fully implementing expansion. Act 117 of 2023 directed the Department of Human Services to pursue a Section 1915(i) State Plan Amendment to add doula services — implementation was expected in 2025.
Where to get help in Pennsylvania
- Federally Qualified Health Centers in Pennsylvania: every FQHC accepts Medicaid, charges on a sliding scale for the uninsured, and has certified application counselors who can help you apply or renew. See our FQHC directory for this state at /clinics/pa/.
- Medicaid-accepting providers in Pennsylvania: our provider directory lets you filter to providers in this state. See /providers/pa/.
- State health profile for Pennsylvania: for state-level health outcomes context (maternal mortality, infant mortality, life expectancy, uninsured rate) by race, see /health/pennsylvania/.
- Pennsylvania Medical Assistance consumer help line: 1-866-550-4355 for application help, renewal questions, and general Medicaid inquiries. Ask for an interpreter if you need one; language access is required under Title VI of the Civil Rights Act.
References & primary sources
- Pennsylvania Medical Assistance, state Medicaid portal: https://www.dhs.pa.gov/Services/Assistance/Pages/Medical-Assistance.aspx.
- KFF State Health Facts: kff.org/statedata. Medicaid income eligibility + enrollment.
- Medicaid.gov: medicaid.gov. Federal program guidance + state plan amendments.
- HHS 2025 Poverty Guidelines (Federal Register Jan 2025): aspe.hhs.gov/poverty-guidelines.
Data refreshed: