Medicaid is a program that helps people get health care when they have limited income. State and federal governments run this program together. If you live in Pennsylvania and meet the income limits and other basic rules, you might qualify. The state uses different rules depending on your age, family size, disability status, and other factors. Most adults under 65 can qualify based on their income alone. A Medicaid planning lawyer can answer any questions you have about your eligibility.
Income Limits and Eligibility Thresholds
Pennsylvania checks your income to see if you qualify for Medicaid. The state uses a measure called Modified Adjusted Gross Income (MAGI) to assess most people’s income. Your MAGI includes your wages, Social Security (not SSI), and other taxable income. An adult without children must have a household income equivalent to 138 percent of the federal poverty level or less in order to qualify. As of 2025, that’s about $21,600 per year for one person. Pregnant women and children have higher income limits. If you live with others, the state compares your total household income to the limit for your household size.
Types of Income That Count (or Don’t Count)
When you apply for Medicaid, the state counts most kinds of income toward your MAGI. That includes wages, pensions, unemployment, rental income, and interest. Pennsylvania also counts your spouse’s income if you live together. However, some types of income don’t count. For example, the state ignores Supplemental Security Income (SSI), SNAP (food stamps), and LIHEAP (home energy help). It also doesn’t count foster care payments or certain child support payments. If you’re unsure about what counts, it’s a good idea to review all of your income with an attorney before you apply.
Non-MAGI Categories and Resource Limits
Some people can qualify for Medicaid using non-MAGI rules. These rules apply if you’re over 65, blind, have a disability, or need long-term care. However, even if the state doesn’t look at your income for this type of eligibility, it will look at your assets. That includes money in the bank, stocks, life insurance, and property that isn’t your home or one vehicle. Most adults in this group only qualify if their income stays below a set monthly limit and their non-exempt assets do not exceed $2,000 in value. If you live with a spouse, Pennsylvania’s asset limit is $3,000.
Threats to Medicaid Coverage in Pennsylvania
It’s possible to lose Medicaid if your income goes up. Pennsylvania checks your income at renewal and sometimes throughout the year. If you get a raise, start a new job, or have someone move into your home, report it right away. These changes could affect your eligibility.
In July of 2025, the Philadelphia Inquirer warned that over 300,000 Pennsylvanians could lose coverage after recent changes to federal Medicaid rules. If your eligibility changes under the new requirements, the state might send you a notice to reapply or switch to Marketplace coverage.
What Can You Do If Your Income Is Too High?
If your income exceeds the Medicaid limit in Pennsylvania, a lawyer can help you explore Medicaid planning options that could allow you to qualify. For example, some people can meet the limits by using a spenddown, which involves subtracting certain medical costs from their income. A lawyer can help you track those expenses and time them in a way that fits the rules. They can help you manage your assets the right way if you need to apply for long-term care, too. An attorney can also guide you through legal methods like setting up a trust or shifting resources to a spouse to help you qualify.
Contact a Pennsylvania Medicaid Planning Attorney
If you have questions about Medicaid or need help with eligibility, talk to the Medicaid planning attorneys at Kreisher Marshall & Associates, LLC. We can look at your income, explain your options, and help you take the right steps. Contact us today to arrange your initial consultation.