Medical Assistance General Eligibility Requirements

General Eligibility Requirements

You must meet income, resource (in some cases), and other eligibility requirements in order to be eligible for Medical Assistance. These categories are grouped by:

  • Adults age 19-64 with incomes at or below 133% of the Federal Income Poverty Guidelines (FPIG) (Identified for Medical Assistance purposes as MAGI-related)
  • Individuals who are aged (age 65 and older), blind and disabled. (Identified for Medical Assistance purposes as SSI-related)
  • Families with children under age 21
  • Special Medical Assistance conditions

Income

Medical Assistance eligibility is determined using income and household size in comparison to income limits. Age and disability are also factors in determining which income limits apply. (Income limits for the various eligibility groups are listed below.)

Examples of income counted in determining eligibility include:

  • Wages (certain deductions are allowed)
  • 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 each category are provided in the section for that category.

Resources

Medical Assistance eligibility for some is also determined using resource and household size in comparison to resource limits. (Resource limits for the various eligibility groups are listed below or in the section for that category.)

NOTE: Resource limits do not apply to persons eligible for - Modified Adjusted Gross Income (MAGI) MA, pregnant women, families with children in the household - under their care and control, and those under the age of 21.

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 provides specific details:

Non-Money Payment (NMP) Medical Assistance

GA-RelatedSSI-Related
One Person = $250One Person = $2,000
Two People = $1,000Two People = $3,000

Medically-Needy Only Medical Assistance

GA or SSI-Related
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 = $7,390
Two Persons = $11,090
NOTE:  There is no resource exclusion for pregnant women, children under 21 or families with children under 21 for Medicare Buy-In Programs.
 
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 aliens. Other aliens may be eligible for limited Medical Assistance benefits if an emergency medical condition exists. U.S. citizens, refugees and legal aliens must submit documentation proving U.S. citizenship or legal alien 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.