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
  • Individuals ages 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 eligibilty 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

  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 = $9,430
        • Two Persons = $14,130

        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