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What income limits qualify households for Medicaid, CHIP, and ACA subsidies in 2025 based on FPL?
Executive summary
Medicaid expansion adults qualify up to about 138% of the federal poverty level (FPL) in expansion states (the statutory 133% becomes ~138% after a 5% disregard) and children, pregnant women, and parents face higher, state-varying caps (examples: children and pregnant women commonly qualify well above 100% FPL) [1] [2]. ACA premium tax credits generally apply to households with incomes between 100% and 400% of FPL for 2025 (with federal actions affecting upper limits through 2025), while CHIP income cutoffs vary by state and often extend to ~200% FPL or higher [3] [4] [5].
1. Medicaid expansion: the 138% rule and what it means for adults
In states that adopted ACA Medicaid expansion, adults 19–64 generally qualify based on income alone if their household income is at or below 133% of the FPL — which, because of a 5% income disregard, is effectively about 138% of FPL. HealthCare.gov frames the statutory floor as 133% but explains the calculation yields approximately 138% [1]. Multiple state guides reiterate that expansion adults are covered to roughly 138% FPL and translate that into dollar thresholds (for a single adult, often cited around $21,597 in 2025 in sources using 138% FPL) [4] [6].
2. Non‑expansion states and narrower adult eligibility
Where states have not expanded Medicaid, adults without qualifying categories (pregnant, parent, disabled, elderly) often do not qualify even at very low incomes. State-by-state charts and guides emphasize that limits vary and that non‑expansion jurisdictions maintain much stricter eligibility tied to categorical rules rather than the expansion percentage [6] [7]. Users should check their state Medicaid agency because the effective income thresholds and covered populations change by state [2].
3. Children and pregnant women: higher, state‑specific thresholds (CHIP overlap)
Children and pregnant women typically qualify for Medicaid or CHIP at higher percentages of FPL than adults. National guides show children’s eligibility thresholds commonly exceed 100%–150% FPL and many CHIP programs extend eligibility to 200% FPL or beyond; some states place children or pregnancy coverage at even higher percentages (examples: children 146%–266% FPL in various state examples; pregnant women up to 195%–263% in some state programs) [2] [8]. Mississippi’s official page shows states apply a 5% FPL disregard and publish state‑specific numeric limits effective March 1, 2025 [9].
4. CHIP: “often 200%+ FPL” but state rules matter
CHIP is explicitly state‑run with federal guidelines; many states set CHIP income cutoffs around or above 200% of FPL, but there is substantial variation and program names differ (CHIP, All Kids, Healthy Families, etc.). Summaries and law‑firm and state pages stress that CHIP limits “often extend to 200% or more” of FPL, so families should consult state materials for precise thresholds [3] [2].
5. ACA premium tax credits: the 100%–400% FPL band (2025 context)
For 2025, most reporting and federal guidance say premium tax credits (subsidies) are targeted to households with incomes between 100% and 400% of FPL, with the federal formula capping premium contributions and therefore subsidies in that band [4] [1]. Federal materials and CMS summaries also note federal policy changes through 2025 modified subsidy rules and the “no‑upper‑limit”/capped percent narratives for specific years — and that program details have changed, so the subsidy landscape for 2025 differs from earlier years [5] [4].
6. Edge cases, dual eligibility, and practical implications
CMS and state guidance explain applicants are screened first for Medicaid/CHIP and then for Marketplace subsidies; people with incomes below Marketplace minimums may be directed to Medicaid, and dually enrolled individuals receive state notices and coordination between agencies [5]. State guides also show families that fall near thresholds should expect different rules for MAGI calculation, household composition, and any asset tests for non‑MAGI programs (e.g., elderly/disabled Medicaid) [9] [2].
7. Why exact dollar numbers vary and where to check
FPL is updated annually and the dollar amounts differ for the contiguous U.S., Alaska, and Hawaii; several sources warn states often begin using the new HHS poverty guidelines for Medicaid/CHIP at variable times (spring 2026 transition noted) and list Alaska/Hawaii exceptions (e.g., 2025 single‑person FPL: $17,990 HI, $19,550 AK in one digest) [10]. Because states set many program limits and apply the 5% disregard, the practical income cutoffs in dollars vary — consult your state Medicaid or CHIP site for the exact 2025 numeric thresholds [9] [6].
Limitations: available sources do not provide a single, comprehensive national table of every state’s 2025 dollar cutoffs in this set; readers should use state Medicaid/CHIP pages and Healthcare.gov for definitive, up‑to‑date figures [9] [1].