Medicaid Income Guidelines in Pennsylvania

In order to qualify for Medicaid, applicants must fall within certain income guidelines. Pennsylvania divides income eligibility requirements into several categories, including families with pregnant women or children of a certain age; aged, blind, or disabled individuals; and people with a limited income or special circumstances.

Families with Children or Pregnant Women

• Income guidelines are determined by comparing a family's income with the Federal Poverty Income Guidelines for the current year. Families with pregnant women and/or children under age 1 must not have an income that is equal to or less than 185 percent of the federal poverty income guidelines in order to qualify. Families with children between the ages of 1 and 5 must have an income that does not exceed 133 percent of the Federal Poverty Income Guidelines. Finally, families with children between the ages of 6 and 19 must have an income that is equal to or less than the Federal Poverty Income Guidelines in order to qualify for Medicaid.

Aged, Blind, or Disabled Persons

• Medicaid benefits for persons who are "aged" (age 65 or older) or who are blind or disabled are related to Social Security income benefits. In order to qualify for Medicaid under this category, a person must be a recipient of Social Security and either be aged, or legally blind or disabled. The applicant's income must be equal to or less than the Federal Poverty Income Guidelines.

People with Limited Income or Special Circumstances

• Families who qualify to receive benefits under the Temporary Assistance for Needy Families (TANF) program qualify to receive Medicaid benefits if the family's income is equal to or less than 25 percent of the Federal Poverty Income Guidelines. Under this arrangement, children of the needy family receive full Medicaid benefits, while adults will have access to a more limited benefit plan.

  Medicaid benefits are also available to adults with disabilities. Adults who are permanently disabled, according to Social Security Administration standards, can receive full Medicaid benefits as long as they do not have an income that exceeds the Federal Poverty Income Guidelines.

  Workers between 16 and 64 who are temporarily disabled will qualify for Medicaid benefits as long as the disability is documented and satisfies Social Security Administration standards, and the worker's income is equal to or less than 250 percent of the Federal Poverty Income Guidelines.

Calculating Income

• Forms of income that will be included to determine eligibility are wages, interest, dividends, Social Security and veteran's benefits, pensions, and spouse's income. For purposes of determining eligibility, benefits from the Temporary Assistance for Needy Families program, as well as benefits from the Low Income Home Energy Assistance Program, food stamps, foster care payments, certain other housing or utility subsidies, and weatherization payments will not be included in the calculation of an applicant's income.