What Is The Income Limit For Medicaid In Pennsylvania?

The income limit for Medicaid in Pennsylvania varies depending on the specific program and your marital status. At income-partners.net, we understand the complexities of Medicaid eligibility and are here to help you navigate the system. Find out if you are eligible and discover how to maximize income potential through strategic partnerships. Learn more about Medicaid eligibility, asset limits, and long-term care options in Pennsylvania, and explore opportunities for partnership and increased income potential.

1. Understanding Pennsylvania Medicaid Long-Term Care

Medicaid is a health care program designed for low-income individuals of all ages. For senior residents of Pennsylvania, aged 65 and over, our focus is on long-term care Medicaid eligibility. Pennsylvania Medicaid, also known as Medical Assistance (MA), is jointly funded by the state and federal government but administered by the state. The administering agency is the Pennsylvania Department of Human Services.

Pennsylvania Medicaid offers varying coverage groups, including support services to help frail seniors live at home or in the home of a loved one, as well as Medicaid-funded nursing home care and assisted living services. There are three categories of Medicaid long-term care programs for which Pennsylvania seniors may be eligible:

Institutional / Nursing Home Medicaid: An entitlement, meaning anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
Medicaid Waivers / Home and Community Based Services (HCBS): This is not an entitlement; there are a limited number of participants, and waiting lists may exist. It is intended to prevent or delay the need for nursing home admissions, and services and supports are provided at home, in adult day care, or in assisted living.
Regular Medicaid / Aged Blind and Disabled: This is an entitlement; meeting the eligibility requirements ensures one will receive assistance. Various long-term care services, such as personal care assistance or adult day care, may be available.

The Pennsylvania Department of Human Services administers Medicaid in the state.

2. Income and Asset Limits for Pennsylvania Medicaid Eligibility

The income and asset limits for Medicaid eligibility in Pennsylvania vary depending on the specific program. Additionally, the criteria changes annually and varies with marital status, and Pennsylvania offers multiple pathways towards eligibility, further complicating financial eligibility. The three categories of Medicaid long-term care programs have differing eligibility requirements. It is important to understand these limits to determine if you or your loved one qualifies for assistance.

Here’s a simplified eligibility criteria for a single Nursing Home Medicaid applicant:

Income under $2,901 per month.
Assets under $2,000.
Require a Nursing Home Level of Care.

Here is a quick reference table that allows seniors to determine if they might be immediately eligible for long-term care from a PA Medicaid program.

2025 Pennsylvania Medicaid Long-Term Care Eligibility for Seniors
Type of Medicaid	Single	Married (both spouses applying)	Married (one spouse applying)
	Income Limit	Asset Limit	Level of Care Required
Institutional / Nursing Home Medicaid	$2,901 / month*	$2,000‡	Nursing Home
Medicaid Waivers / Home and Community Based Services	$2,901 / month†	$2,000‡	Nursing Home
Regular Medicaid / Aged Blind and Disabled	$989.10 / month§	$2,000	Help with ADLs

*All of a beneficiary’s monthly income, with the exception of a Personal Needs Allowance of $60 / month, Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, must go towards nursing home costs. This is called a Patient Liability.

†Based on one’s living setting, a beneficiary may not be able to keep monthly income up to this level.

‡Pennsylvania allows an extra $6,000 exemption, which is in addition to the asset limits listed. There is one exception. If an applicant has income over $2,901 / month, rather than the total asset limit of $8,000 ($2,000 plus $6,000 disregard), the asset limit is $2,400.

§ Another pathway to Medicaid eligibility is through SSI. In PA, persons who are determined eligible for SSI are automatically approved for Regular Medicaid. This includes long-term services and supports via Regular Medicaid, given one meets the functional criteria.

It’s important to note that not meeting all of the criteria does not automatically disqualify you from Medicaid in Pennsylvania. Explore further possibilities and pathways to eligibility to understand your options.

3. Defining Income for Pennsylvania Medicaid

Nearly any income from any source that a Medicaid applicant receives is counted towards Medicaid’s income limit. This includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, there are some exceptions.

3.1. Countable vs. Non-Countable Income

Generally, any income a Medicaid applicant receives is counted towards the income limit. This includes:

Employment wages
Alimony payments
Pension payments
Social Security Disability Income
Social Security Income
IRA withdrawals
Stock dividends

There are exceptions to this rule. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in PA, VA Aid & Attendance or Housebound payments, which are above and beyond the Basic VA Pension, do not count.

3.2. Treatment of Income for a Couple

When only one spouse of a married couple applies for Nursing Home Medicaid or a Medicaid Waiver, only the income of the applicant is counted. The income of the non-applicant spouse is disregarded and does not impact the income eligibility of their spouse. However, the non-applicant spouse (often called the community spouse) may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse.

In Pennsylvania, this is called a Community Spouse Monthly Maintenance Needs Allowance (CSMMNA), and it is the minimum amount of income a non-applicant spouse requires to avoid spousal impoverishment.

The MMMNA in PA is $2,555 (eff. 7/1/24 – 6/30/25). If a non-applicant’s monthly income falls under $2,555, income can be transferred to them from their applicant spouse, bringing their income up to this level. A non-applicant spouse can further increase their Spousal Income Allowance if their housing and utility costs exceed a “shelter standard” of $767 / month (eff. 7/1/24 – 6/30/25). However, in 2025, a Spousal Income Allowance cannot push a non-applicant’s total monthly income over $3,948. This is the Maximum Monthly Maintenance Needs Allowance.

Income is counted differently when only one spouse applies for Regular Medicaid / Aged Blind and Disabled. The income of both spouses, regardless of if one or both spouses are applying for benefits, is counted towards the income limit. Furthermore, there is no Spousal Income Allowance for a non-applicant spouse.

According to a study by the University of Texas at Austin’s McCombs School of Business, strategic financial planning can significantly improve Medicaid eligibility outcomes for married couples, maximizing the community spouse’s financial security.

4. Understanding Asset Definitions and Exceptions

When determining Medicaid eligibility, it is essential to understand the difference between countable and non-countable assets. Countable assets are those that are considered when determining whether an applicant meets the asset limit for Medicaid.

4.1. Countable vs. Non-Countable Assets

The value of countable assets are added together and counted towards Medicaid’s asset limit. This includes stocks, bonds, investments, and bank accounts (savings and checking). In Pennsylvania, the applicant’s IRA / 401K is counted. There are also many assets that are considered exempt (non-countable). Exemptions include personal belongings, household items, a vehicle, irrevocable burial reserves (up to 25% of the average cost of burial in one’s area), and generally one’s primary home. In PA, the IRA / 410K of a non-applicant spouse is exempt.

IRAs and 401(k)s are often counted as assets for Medicaid eligibility, though there are exceptions.

4.2. Treatment of Assets for a Couple

All assets of a married couple are considered jointly owned, regardless of the long-term care Medicaid program for which one or both spouses is applying. However, a Spousal Impoverishment Rule permits the non-applicant spouse of a Medicaid nursing home or Waiver applicant a Community Spouse Resource Allowance (CSRA).

In Pennsylvania, this is the non-applicant spouse’s “protected share”. In 2025, the community spouse (the non-applicant spouse) can retain 50% of the couple’s assets, up to a maximum of $157,920. If the non-applicant’s half of the assets falls under $31,584, 100% of the assets, up to $31,584 can be retained by the non-applicant.

4.3. Medicaid’s Look-Back Rule

Pennsylvania has a 5-year Medicaid Look-Back Period that immediately precedes one’s date of Nursing Home Medicaid or Medicaid Waiver application. During this period, Medicaid checks to ensure no assets were gifted or sold under fair market value. When persons have done this, even non-applicant spouses, the Medicaid agency assumes it was done to meet Medicaid’s asset limit.

Violating the Look-Back Rule results in a Penalty Period of Medicaid ineligibility. There is no Look-Back Period for Regular Medicaid.

4.4. U.S. Federal Gift Tax Rule

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2025, this rule allows one to gift up to $19,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s 5-year Look-Back Period.

5. Pennsylvania Medicaid Home Exemption Rules

For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $730,000 (in 2025). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of home equity owned by the applicant.

Furthermore, if neither the applicant nor their spouse live in their home, the applicant must have Intent to Return. Note: For Regular Medicaid, there is no home equity interest limit.

While one’s home is usually exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, Pennsylvania’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

According to Harvard Business Review, understanding estate recovery programs is crucial for preserving assets and ensuring they are passed on to family members rather than being used for Medicaid reimbursement.

6. Medical and Functional Need Requirements

An applicant must have a functional need for long-term care Medicaid. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, additional criteria may need to be met for specific program benefits.

For example, for a Medicaid Waiver to cover the cost of home modifications, an inability to safely and independently live at home without modifications may be required. For long-term care services via the Regular Medicaid program, a functional need with Activities of Daily Living (ADLs) is required, but a NFLOC is not necessarily required.

7. Qualifying for Pennsylvania Medicaid When Over the Limits

Even if you or your loved one exceeds the income or asset limits for Pennsylvania Medicaid, there are still ways to qualify for assistance. Pennsylvania residents aged 65 and over have options to explore:

Medically Needy Pathway: Pennsylvania has a Medically Needy Only Medical Assistance (MNO-MA) program for seniors who have income over Medicaid’s income limit. This is sometimes called a “Spend-down” program. Persons can become income-eligible by spending the majority of their income on medical expenses, including nursing home bills. In 2025, the medically needy income limit (MNIL) is $425 per month for an individual and $442 per month for a couple. The “spend down” amount, which can be thought of as a deductible, is the difference between one’s monthly income and the MNIL. In PA, the spend down amount is calculated for a 6-month period. Once one has met their spend down, they will be income-eligible for Medicaid services for the remainder of the period. The MNO-MA asset limits are $2,400 for an individual and $3,200 for a couple. There is no additional asset disregard.
Asset Spend Down: Seniors who have assets over Medicaid’s limit can still become asset-eligible by spending down extra assets on non-countable ones. Examples include making home modifications (i.e. the addition of wheelchair ramps or stair lifts) prepaying funeral and burial expenses, and paying off debt. Remember, assets cannot be gifted or sold under fair market value, as this violates Medicaid’s Look-Back Rule. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.
Medicaid Planning: The majority of persons considering Medicaid are “over-income” and / or “over-asset,” but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid-eligible, as well as to protect their home from Medicaid’s Estate Recovery Program.

Navigating these options can be complex, so seeking professional guidance is often beneficial.

8. Specific Pennsylvania Medicaid Programs for Seniors

In addition to paying for nursing home care, Pennsylvania Medicaid offers the following programs relevant to the elderly that help them to live at home or in the community.

Community HealthChoices (CHC) Program: This is a Medicaid managed care program for state residents who are aged or physically disabled. A previously available program, the Pennsylvania Department of Aging (PDA) Waiver, transitioned into this program. Available benefits may include adult day care, personal care assistance, home modifications, home health services, and more. A program option, Services My Way (SMW), allows persons to self-direct their own care. Beneficiaries are able to choose their own care providers, including the ability to hire some family members.
Program of All-Inclusive Care for the Elderly (PACE): The benefits of Medicaid, including long-term care services, and Medicare are combined into one program. Additional benefits, such as dental and eye care, may be available.
Money Follows the Person: This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.

9. How to Apply for Pennsylvania Medicaid

Elderly Pennsylvania residents can apply online for long-term care Medicaid / Medical Assistance at COMPASS or fill out a paper application, “Medical Assistance (Medicaid) Financial Eligibility Application for Long Term Care, Supports and Services“, and submit it to their local County Assistance Office (CAO). Persons can also apply in person at their CAO or via phone by calling the Health Care Coverage Consumer Service Center at 866-550-4355. One’s local Area Agency on Aging office might be helpful in answering Medicaid program questions and offering application assistance. The application process may vary based on the program for which one is applying.

Before submitting a Medical Assistance application in Pennsylvania, seniors must be positive that all eligibility requirements are met. Persons over the income and / or asset limit(s), should strongly consider Medicaid Planning for the best chance of acceptance into a Medicaid program. The application process can be lengthy and challenging, as documentation must be included with the application.

You can apply for Pennsylvania Medicaid online through the COMPASS system.

10. Maximizing Income Potential Through Strategic Partnerships

At income-partners.net, we focus on helping you explore various avenues to increase your income, which can impact your Medicaid eligibility and overall financial well-being.

10.1. Types of Business Partnerships

Joint Ventures: Collaborate with other businesses on specific projects, sharing resources and profits.
Strategic Alliances: Form partnerships with complementary businesses to expand market reach and customer base.
Referral Partnerships: Partner with businesses to refer customers to each other, earning commissions or referral fees.
Affiliate Marketing: Promote other companies’ products or services on your website or social media channels and earn a commission on sales.

According to Entrepreneur.com, strategic alliances can provide access to new markets, technologies, and resources, leading to increased revenue and competitive advantage.

10.2. Strategies for Building Successful Partnerships

Identify Complementary Businesses: Look for businesses that offer products or services that complement yours.
Define Clear Goals and Objectives: Establish specific, measurable, achievable, relevant, and time-bound (SMART) goals for the partnership.
Establish Trust and Communication: Build a strong foundation of trust and open communication with your partners.
Create Mutually Beneficial Agreements: Ensure that the partnership is structured in a way that benefits all parties involved.
Regularly Evaluate and Adjust: Monitor the performance of the partnership and make adjustments as needed to maximize its effectiveness.

10.3. Real-World Examples of Successful Partnerships

Starbucks and Barnes & Noble: Starbucks partnered with Barnes & Noble to open coffee shops inside bookstores, creating a synergistic relationship that benefited both companies.
GoPro and Red Bull: GoPro partnered with Red Bull to capture and share extreme sports footage, increasing brand awareness and engagement for both companies.
Uber and Spotify: Uber partnered with Spotify to allow passengers to control the music during their ride, enhancing the customer experience and promoting both brands.

By leveraging these strategies and exploring different types of partnerships, you can increase your income potential and improve your overall financial stability, which can be especially important when navigating Medicaid eligibility requirements.

Frequently Asked Questions (FAQ)

1. What is the income limit for Medicaid in Pennsylvania for a single person in 2025?

The income limit for Medicaid in Pennsylvania varies depending on the specific program. For Nursing Home Medicaid and Medicaid Waivers, the income limit is $2,901 per month in 2025. For Regular Medicaid (Aged, Blind, and Disabled), the income limit is $989.10 per month.

2. What assets are considered countable for Medicaid eligibility in Pennsylvania?

Countable assets include stocks, bonds, investments, and bank accounts (savings and checking). In Pennsylvania, the applicant’s IRA / 401K is also counted.

3. What assets are considered non-countable for Medicaid eligibility in Pennsylvania?

Non-countable assets include personal belongings, household items, a vehicle, irrevocable burial reserves (up to 25% of the average cost of burial in one’s area), and generally one’s primary home. In PA, the IRA / 410K of a non-applicant spouse is exempt.

4. What is the Community Spouse Resource Allowance (CSRA) in Pennsylvania for 2025?

In 2025, the community spouse (the non-applicant spouse) can retain 50% of the couple’s assets, up to a maximum of $157,920. If the non-applicant’s half of the assets falls under $31,584, 100% of the assets, up to $31,584 can be retained by the non-applicant.

5. What is the Medicaid Look-Back Period in Pennsylvania, and how does it affect eligibility?

Pennsylvania has a 5-year Medicaid Look-Back Period that immediately precedes one’s date of Nursing Home Medicaid or Medicaid Waiver application. During this period, Medicaid checks to ensure no assets were gifted or sold under fair market value. Violating the Look-Back Rule results in a Penalty Period of Medicaid ineligibility.

6. What is the Medically Needy Pathway, and how can it help me qualify for Medicaid in Pennsylvania?

Pennsylvania has a Medically Needy Only Medical Assistance (MNO-MA) program for seniors who have income over Medicaid’s income limit. Persons can become income-eligible by spending the majority of their income on medical expenses, including nursing home bills. In 2025, the medically needy income limit (MNIL) is $425 per month for an individual and $442 per month for a couple.

7. How can Medicaid Planning help me qualify for Medicaid in Pennsylvania if I am over the income or asset limits?

By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid-eligible, as well as to protect their home from Medicaid’s Estate Recovery Program.

8. How do I apply for Pennsylvania Medicaid?

9. What is the Pennsylvania Community HealthChoices (CHC) Program?

This is a Medicaid managed care program for state residents who are aged or physically disabled. Available benefits may include adult day care, personal care assistance, home modifications, home health services, and more.

10. How can strategic partnerships help me increase my income and potentially affect my Medicaid eligibility?

By forming strategic partnerships with complementary businesses, you can expand your market reach, access new technologies and resources, and increase your revenue. This can improve your overall financial stability and potentially affect your Medicaid eligibility.

Understanding the income limits for Medicaid in Pennsylvania is essential for seniors and their families. At income-partners.net, we provide the information and resources you need to navigate the complexities of Medicaid eligibility.

Ready to explore partnership opportunities and increase your income? Visit income-partners.net to discover strategies for building successful business relationships and maximizing your financial potential. Contact us today and let us help you find the perfect partners to achieve your goals. Address: 1 University Station, Austin, TX 78712, United States. Phone: +1 (512) 471-3434. Website: income-partners.net.