The Medicaid Income Limit is the most important criteria for deciding whether you qualify for Medicaid in your state. In this post, we are going to explain in detail the Pennsylvania Medicaid Income Limits for 2021. Medicaid in Pennsylvania is called Medical Assistance (MA).
Based on this information, you will be able to determine whether your income qualifies you for Pennsylvania Medicaid or not.
However, before we get into details about the income limit, we will first explain the Medicaid program in Pennsylvania and how it works.
Next, we will discuss who is eligible for Medicaid, including how eligibility works for various categories, including Children, Pregnant Women, and Adults.
What is Medicaid?
Medicaid is a federal and state health insurance program for people with a low income.
It provides free or low-cost health coverage to millions of Americans, including families and children, pregnant women, the elderly, and people with disabilities.
The Children’s Health Insurance Program (CHIP) offers health coverage to children in families with incomes too high to qualify for Medicaid, but who can’t afford private coverage.
How Many People are on Medicaid?
According to the Centers for Medicare & Medicaid Services, as of November 2020, here are the number of people enrolled in Medicaid and Chip in the entire United States:
- 78,521,263 individuals were enrolled in Medicaid and CHIP
- 72,204,587 individuals were enrolled in Medicaid
- 6,695,834 individuals were enrolled in CHIP
The Pennsylvania Medicaid program provides medical coverage to low-income individuals and families.
As of 2020, the program, along with the Children’s Health Insurance Program (CHIP) covered 3.2 million people.
This includes about 1.5 million children as shown by the image below.
The Pennsylvania Medicaid program is managed by the Department of Human Services (DHS)
Who Can Get Medicaid in Pennsylvania?
You should apply for Medicaid if your income is low and you match one of the descriptions below:
- You think you are pregnant
- The parent or caretaker of a child and/or teenager under the age of 19.
- You are a child or teenager age 18 or under.
- An adult age 65 or older.
- You are legally blind.
- Living with a disability or disabled.
- You are in need of nursing home care.
Pennsylvania Medicaid Income Limit
The Pennsylvania Medicaid Income Limit is calculated as a percentage of the Federal Poverty Line.
To qualify, you must meet the Pennsylvania Medicaid Income limits listed below.
Here is the Federal Poverty Level (FPL) for 2021.
|2021 Federal Poverty Levels for the 48 Contiguous States & D.C.|
|Household Size||Poverty Guideline for 48 states & DC||Alaska||Hawaii|
|Over 8 people||add $4,540 for each additional person||$5,680||$5,220|
Additionally, to be eligible for Medicaid, you cannot make more than the income guidelines outlined below:
- Children up to age 1 with family income up to 215 percent of FPL
- Any child age 1-5 with a family income up to 157 percent of FPL
- Children ages 6- 18 with family income up to 133 percent of FPL
- CHIP for children with family income up to 314 percent of FPL
- Pregnant women with family income up to 215 percent of FPL
- Parents of minor children with family income up to 33 percent of FPL
- Individuals who are elderly, blind, and disabled with family income up to 74% of the FPL
- Adults without dependents under Medicaid expansion with income up to 133% of the FPL
Pennsylvania Medicaid Income Limit Charts
The Pennsylvania Medicaid eligibility income limit charts are divided by groups.
For example, the first chart is focused on income limits for children who qualify for Medicaid.
Similarly, the second chart below focuses on the Medicaid income limits for adults in Pennsylvania who qualify for Medicaid.
Pennsylvania Medicaid Income Limit for Children
Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.
|Pennsylvania Medicaid Income Limit – Children|
|Children Medicaid Ages 0-1||Children Medicaid Ages 1-5||Children Medicaid Ages 6-18||Children Separate CHIP|
Next is the income limit for adults by category. Find the category you fall into and you will see the income limit by household size.
Pennsylvania has expanded Medicaid to include adults without dependents.
Therefore, adults without dependents can apply for Medicaid in Pennsylvania.
For an update on the Medicaid expansion debate and timeline in Pennsylvania, see our Pennsylvania Expansion update below.
Pennsylvania Medicaid Income Limit for Adults
|Pennsylvania Medicaid Income Limit – Adults|
|Pregnant Women Medicaid||Adults (Medicaid) Parent/ Caretaker||Seniors & People w/ Disabilities (Medicaid)||Adults (Medicaid) Expansion to Adults|
How to Read the Pennsylvania Medicaid Income Limits Charts Above
You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.
Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.
For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 215% of the Federal Poverty Level – which for a family of two is $37,453 as shown in the chart above.
How to Apply for Pennsylvania Medicaid
There are 3 ways you can apply for Medicaid in Pennsylvania.
Option 1 – Apply online
You can apply online through the MyCOMPASS PA Portal – as shown in the image below.
If you have an account, you can log in or create your MyCOMPASS PA account. Click here to be taken to the website.
Option 2 – Apply at a County Assistance Office Near You
You can apply in person at the County Assistance Office (CAO) office near you. Click here to locate a CAO office.
Option 3 – Download Application
You can download an application, complete it, and mail it to your County Assistance Office (CAO) office or submit it in person.
Additionally, you can Call the Consumer Service Center for Health Care Coverage at 1-866-550-4355.
Pennsylvania Medicaid Phone Number
Here’s how to contact the Pennsylvania Medicaid Agency:
For Medicaid Applicant & Member Services
Call the Consumer Service Center for Health Care Coverage at 1-866-550-4355.
Pennsylvania Medicaid Expansion Update
The state of Pennsylvania expanded Medicaid under the ACA in 2015.
Nearly 700,000 people are covered under Pennsylvania’s Medicaid expansion.
Medicaid expansion has played a significant role in the declining uninsured rate in Pennsylvania.
According to U.S. Census data, the uninsured rate fell from 9.7 percent in 2013 to 5.5 percent in 2017.
Lawmakers passed Medicaid work requirement bills in 2017 and 2018, but Gov. Wolf vetoed them.
Pennsylvania Medicaid Income Limits Summary
We hope this post on Pennsylvania Medicaid Income Limits was helpful to you.
If you have any questions about Medicaid in the state of Pennsylvania, you can ask us in the comments section below.
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Be sure to check out our other articles about Medicaid.
Income limits for Florida Medicaid
Alabama Medicaid Income Limits and How to Apply
Alaska Medicaid Income Limits and Chart
Rhode Island Medicaid Income Limits