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Pennsylvania Medicaid for pregnant women

Who qualifies for Medical Assistance (Pennsylvania Medicaid), the income limit for your household size, what it covers and how to apply with Pennsylvania Department of Human Services.

Limits as of January 2026 · Checked October 2026 · 26 sources

Apply for Medical Assistance (Pennsylvania Medicaid)

Pennsylvania Department of Human Services runs it. We're not the state agency, so you apply with them, online or with help from your clinic or hospital.

Start your application

Opens pa.gov

Check your income against the limit

Short answer

In Pennsylvania, you qualify for pregnancy Medicaid if your household earns up to 220% of the poverty level: about $47,608 a year for a household of two (you and the baby). Coverage lasts 12 months after birth. A qualified clinic or hospital can enroll you the same day.

Pennsylvania pregnancy Medicaid income limits for 2026

Find your household size and compare your household's income with the limit. Medical Assistance (Pennsylvania Medicaid) covers pregnancy up to 220% of the federal poverty level.

Medical Assistance (Pennsylvania Medicaid) income limits2026 guidelines, 48 states and DC
HouseholdPer yearPer month
2you + 1 baby$47,608$3,967
3$60,104$5,009
4$72,600$6,050
5$85,096$7,091
6$97,592$8,133
7$110,088$9,174
8$122,584$10,215

Annual and monthly household income. See the 2026 poverty guidelines

Your baby counts

For Medicaid, a pregnant woman's family size counts her plus the number of children she is expected to deliver (42 CFR 435.603(b)). A household of three in Pennsylvania, two adults expecting one baby, can earn up to $60,104 a year ($27,320 × 220%).

Limits are percents of the poverty level from KFF and Georgetown CCF (January 2026) and include the standard 5-point income disregard. Pennsylvania rounds and updates on its own schedule, so treat the dollars as approximate.

Sources: KFF State Health Facts; U.S. Department of Health and Human Services (Federal Register); eCFR (National Archives). Data as of October 2026.

How to apply in Pennsylvania

  1. Count your household

    Count yourself plus each baby you're expecting, and anyone else the state counts with you. Find your size in the table above.

  2. Apply with Pennsylvania Department of Human Services

    Apply on the state's site (pa.gov). Go to the Medical Assistance (Pennsylvania Medicaid) application

  3. Ask for same-day coverage

    At your first prenatal visit, ask whether the clinic can enroll you through presumptive eligibility while your application is processed.

  4. Keep your coverage after birth

    Medical Assistance (Pennsylvania Medicaid) covers you for 12 months after the pregnancy ends.

Get covered today

Yes

Presumptive eligibility lets a qualified clinic or hospital enroll a pregnant person in temporary Medicaid right away, while the full application is processed.

Pennsylvania uses it for pregnancy. Ask at your first prenatal visit whether the clinic can enroll you.

Source: KFF and Georgetown University Center for Children and Families. Data as of January 2025.

12 months

of Medical Assistance (Pennsylvania Medicaid) coverage after birth, since April 1, 2022

KFF postpartum tracker, July 2026

What Medical Assistance (Pennsylvania Medicaid) covers for pregnancy

Coverage after birth, plus the three extras people ask about most, each from our state-by-state trackers.

After birth

12 months
Medical Assistance (Pennsylvania Medicaid) keeps covering you for 12 months after the pregnancy ends, a rule in place since April 1, 2022.
Postpartum coverage in every state

Doula care

Yes
In Pennsylvania, Medicaid covers doula care: up to $2,200 per pregnancy for 12 prenatal or postpartum visits a year, plus support during labor and delivery.We list 495 doulas in Pennsylvania.
Doulas in PennsylvaniaDoula coverage in every state

Lactation support

Limited
In Pennsylvania, Medical Assistance health plans address lactation care through their home visiting programs, and we found no separate lactation consultant benefit.
Lactation consultants in PennsylvaniaLactation coverage in every state

Breast pump

Yes
In Pennsylvania, Medical Assistance covers electric breast pumps with a prescription and no prior authorization.
Breast pump rules in Pennsylvania and every state

What's changing

Rules that affect pregnancy coverage in Pennsylvania now and in 2027.

Sources: U.S. Government Publishing Office; Centers for Medicare & Medicaid Services; KFF and Georgetown University Center for Children and Families

More for families in Pennsylvania

All 50 states and DC

Questions about pregnancy Medicaid in Pennsylvania

What is the income limit for pregnancy Medicaid in Pennsylvania?

Medical Assistance (Pennsylvania Medicaid) covers pregnancy for household incomes up to 220% of the federal poverty level. At the 2026 guidelines that's about $47,608 a year for a household of two, $60,104 for three and $72,600 for four. Limits are KFF's figures as of January 2026.

Does my unborn baby count in my household size?

Yes. For Medicaid, a pregnant woman's family size counts her plus the number of children she is expected to deliver (42 CFR 435.603(b)). A single pregnant woman expecting one baby is a household of two; expecting twins, a household of three.

How long does Medical Assistance (Pennsylvania Medicaid) cover you after birth?

12 months after the pregnancy ends, a rule in place since April 1, 2022.

Can I get covered the same day in Pennsylvania?

Yes. Pennsylvania uses presumptive eligibility for pregnancy, so a qualified clinic or hospital can enroll you in temporary Medicaid the same day while your full application is processed.

How do I apply for pregnancy Medicaid in Pennsylvania?

Apply with Pennsylvania Department of Human Services at pa.gov. Count yourself plus each baby you're expecting as your household, and compare your income with the limit for that size. We're not the state agency and can't take applications.

Does Medical Assistance (Pennsylvania Medicaid) pay for a doula?

In Pennsylvania, Medicaid covers doula care: up to $2,200 per pregnancy for 12 prenatal or postpartum visits a year, plus support during labor and delivery.

Do pregnant women have to meet the new Medicaid work requirements?

Public Law 119-21 (2025) requires states to apply Medicaid work (community engagement) requirements to expansion adults ages 19-64 starting no later than January 1, 2027 (states may start earlier; HHS may grant good-faith exemptions that end by December 31, 2028). People who are pregnant or entitled to postpartum coverage are exempt, as are parents and caretakers of a dependent child 13 or younger.

We're not Pennsylvania Department of Human Services and can't tell you whether you qualify. Apply at pa.gov for a decision. Spot something out of date? Tell us and we'll check it against the state's own notice.

Sources

  1. 1.Medicaid and CHIP Income Eligibility Limits for Pregnant Women as a Percent of the Federal Poverty Level (as of January 2026) KFF State Health Facts. Accessed October 9, 2026.
  2. 2.Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies as States Prepare for Major Medicaid Policy Changes (Table 2, January 2026) KFF and Georgetown University Center for Children and Families. Accessed October 9, 2026.
  3. 3.Medicaid Postpartum Coverage Extension Tracker (as of July 15, 2026) KFF. Accessed October 9, 2026.
  4. 4.Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies as States Resume Routine Operations Following the Unwinding (Table 7: Presumptive Eligibility, January 2025) KFF and Georgetown University Center for Children and Families. Accessed October 9, 2026.
  5. 5.Medical Assistance (Pennsylvania Medicaid): how to apply Pennsylvania Department of Human Services. Accessed October 9, 2026.
  6. 6.CMS approval of Pennsylvania State Plan Amendment PA-22-0016 (12-month postpartum coverage), effective 2022-04-01 Centers for Medicare & Medicaid Services. Accessed October 9, 2026.
  7. 7.Annual Update of the HHS Poverty Guidelines (91 FR 1797, Jan. 15, 2026) U.S. Department of Health and Human Services (Federal Register). Accessed October 9, 2026.
  8. 8.42 CFR 435.603(b), definition of family size eCFR (National Archives). Accessed October 9, 2026.
Show all 26 sources
  1. 9.Public Law 119-21, sec. 71119: Requirement for States to Establish Medicaid Community Engagement Requirements (adds SSA sec. 1902(xx)) U.S. Government Publishing Office. Accessed October 9, 2026.
  2. 10.SHO #26-001: Implementation of Section 71109 "Alien Medicaid Eligibility" (April 8, 2026) Centers for Medicare & Medicaid Services. Accessed October 9, 2026.
  3. 11.42 CFR 447.56(a)(2)(ii), exemptions from Medicaid cost sharing: pregnancy-related services eCFR / Code of Federal Regulations.
  4. 12.Doula Medicaid Project: state-by-state chart of doula Medicaid efforts (last updated Sep. 2026) National Health Law Program (NHeLP). Accessed October 9, 2026.
  5. 13.MA Bulletin 09-25-33 et al.: Coverage of and Payment for Doula Services in the Medical Assistance Program (issued Dec 23, 2024; effective Jan 1, 2025), copy hosted by Keystone First Pennsylvania Department of Human Services (hosted by Keystone First). Accessed October 9, 2026.
  6. 14.Doula FAQ Document (provider enrollment) Pennsylvania Department of Human Services. Accessed October 9, 2026.
  7. 15.Provider Enrollment Documents (Non-Traditional Provider PT 13, Perinatal Doula training) Pennsylvania Department of Human Services. Accessed October 9, 2026.
  8. 16.Certified Perinatal Doula Pennsylvania Certification Board. Accessed October 9, 2026.
  9. 17.Doula Advisory Board Pennsylvania Department of Human Services. Accessed October 9, 2026.
  10. 18.State Trends in Medicaid Coverage of Doula Services (published April 1, 2026; data as of March 2026) National Academy for State Health Policy (NASHP). Accessed October 9, 2026.
  11. 19.HealthChoices Physical Health Agreement effective January 1, 2024 (including exhibits and non-financial appendices) Pennsylvania Department of Human Services. Accessed October 9, 2026.
  12. 20.AmeriHealth Caritas Pennsylvania 2026 Member Handbook AmeriHealth Caritas Pennsylvania. Accessed October 9, 2026.
  13. 21.MA Fee Schedule Pennsylvania Department of Human Services. Accessed October 9, 2026.
  14. 22.Medicaid Coverage of Pregnancy-Related Services: Findings from a 2021 State Survey KFF. Accessed October 9, 2026.
  15. 23.Medical Assistance Bulletin 05-22-14 et al.: Disposable Breast Milk Collection and Storage Bags and Breast Pump Pennsylvania Department of Human Services, Office of Medical Assistance Programs. Accessed October 9, 2026.
  16. 24.55 Pa. Code Chapter 1123. Medical Supplies Pennsylvania Code and Bulletin (Legislative Reference Bureau). Accessed October 9, 2026.
  17. 25.Clinical Policy CCP.1051: Breast Pumps (AmeriHealth Caritas Pennsylvania and Keystone First) AmeriHealth Caritas Pennsylvania. Accessed October 9, 2026.
  18. 26.Electric Breast Pump Limitations and Reimbursement Rate Change (provider notice) AmeriHealth Caritas Pennsylvania. Accessed October 9, 2026.