How do 2025 FPL percentages translate to Medicaid and CHIP eligibility limits by state?
Executive summary
Medicaid and CHIP eligibility is set as percentages of the Federal Poverty Level (FPL), but those percentages—and who they apply to—vary sharply by state and by coverage group: most Medicaid-expansion adults qualify up to 138% FPL (including a 5% disregard) in expansion states, while CHIP and state programs commonly extend to 200% FPL or higher for children, and some states layer additional higher thresholds or dollar-based rules [1] [2] [3]. State-by-state lists and CMS tables are the authoritative sources because many states set different percent‑of‑FPL cutoffs for children, pregnant people, parents, and waiver or Basic Health Program groups [3] [4].
1. How FPL percentages are used in practice — one metric, many rules
Federal guidance and program rules express income limits as a percentage of the FPL, but those percentages do not create a single national cutoff. The Modified Adjusted Gross Income (MAGI) rules normally apply and include an effective 5% FPL “disregard” when computing eligibility, so a stated 133% or 138% standard reflects that adjustment in practice [3] [2]. CMS notes that MAGI‑based groups and their percentages vary across states and coverage categories; the national Medicaid/CHIP table is the place to see those differences [3].
2. Adults under expansion vs. non‑expansion states — the core divide
In states that expanded Medicaid under the ACA, the common adult threshold is 138% of the FPL (which accounts for the 5% disregard), meaning non‑elderly adults with incomes at or below that level qualify for full Medicaid [2]. The CMS overview and several explainers repeat that distinction: if a state has not expanded Medicaid, adults without dependent children often remain ineligible even at very low incomes, producing coverage gaps [2] [5].
3. Children and CHIP — far higher ceilings in many states
Children’s eligibility routinely reaches well above the adult expansion threshold. CHIP and state child coverage programs typically set higher percentages—commonly 200% FPL or greater—and some states go well beyond that for certain age bands (for example, state programs covering children up to 317% FPL in parts of California) [1] [3]. State pages (e.g., Mississippi) publish concrete percent and dollar limits by age and household size, illustrating variation [6].
4. Pregnant people, parents and special groups — multiple cutoffs
Pregnant people, parents/caretaker relatives, and other MAGI groups often have distinct rules. Some states cover pregnant people at substantially higher percentages of FPL than non‑pregnant adults; others use dollar limits or county‑specific rules for parents [3] [7]. GovFacts and state pages show examples where pregnant people are eligible at around 195% FPL or higher while children or parent groups use separate bands [7] [6].
5. State innovations and waivers change the math
States can and do create alternate programs (BHPs, waivers) that expand coverage to people above typical Medicaid thresholds. Minnesota and Oregon operate Basic Health Programs covering consumers up to around 200% FPL, and New York reported programs extending to 250% in some cases—showing that an FPL percentage for “eligibility” can be bypassed by state policy choices [4] [3].
6. Dollars behind the percentages — the 2025 FPL numbers to watch
The 2025 HHS FPL figures matter because percentages multiply those base numbers; for 2025 the contiguous‑U.S. FPL for one person is $15,650, Alaska $19,550, Hawaii $17,990, and family increments are defined per HHS [8] [9]. That makes 138% FPL roughly $21,597 for a single person in the continental U.S., which many sources use as the adult‑expansion threshold example [10] [9].
7. Practical takeaways for people checking eligibility
To translate “X% of FPL” into whether you qualify: (a) start with the correct 2025 FPL dollar for your state and household size, (b) multiply by the state’s published percent for the specific coverage group (adult, child, pregnant person, parent), and (c) remember states may apply the 5% MAGI disregard and may use dollar cutoffs instead of percentages [3] [6]. State Medicaid and CHIP web pages and the CMS national table are the definitive references for the exact percentages and effective dollar limits [3] [6].
8. Limits of available reporting and where to verify
Available sources comprehensively describe the framework and give examples, but exact, up‑to‑the‑day state cutoffs must be read on state Medicaid/CHIP pages or the CMS eligibility table; summaries and guides (Jarvis, GovFacts, Ventuer) provide helpful context but are not substitutes for state rules [1] [7] [10]. CMS’s Medicaid/CHIP eligibility table and state program pages are the authoritative sources to convert 2025 FPL percentages into precise dollar eligibility thresholds [3] [6].