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Which states have expanded Medicaid as of 2025 and what income limits do they use?
Executive Summary
As of 2025, the available analyses disagree on the exact number of states that have adopted Medicaid expansion, with the majority of sources reporting 41 states plus the District of Columbia expanded Medicaid and a minority reporting different counts (notably 38 or “all states” in one report). All analyses that specify an income limit point to 138% of the Federal Poverty Level (FPL) as the standard threshold applied in expansion states, which translates to about $21,597 annually for a single adult under the 138% metric cited in these summaries; several state-level guides note variations and caveats in how FPL is applied or adjusted by family size and local guidelines [1] [2] [3] [4] [5].
1. Numbers Don’t Fully Agree — Who Says What and When
The summaries present a primary narrative that 41 states and DC have expanded Medicaid by mid-2025, a stance reflected in multiple analyses that use KFF-style tracking of expansion decisions and enrollment snapshots [1] [5]. An alternate analysis dated July 12, 2025 reports 38 states plus DC in expansion status, highlighting that tracking can diverge depending on cut-off dates or definitions of “adopted” versus “implemented” [3]. One outlier claims all states expanded and provides differing income amounts and metrics; this stands in contrast to the consensus and likely reflects a different methodology or an error in classification [6]. The disagreement underscores how timing, definition, and data aggregation choices alter headline counts, and it matters for policy tracking and eligibility guidance [1] [3] [6].
2. Income Limits: 138% FPL Dominates, But Details Matter
Across the analyses that specify income rules, the consistent figure for expansion eligibility is 138% of the Federal Poverty Level, which is repeatedly cited as the benchmark for adult eligibility under Medicaid expansion and translated into dollar figures for individuals and families in 2025 [1] [4] [5]. Several state-level guides emphasize that income is measured using Modified Adjusted Gross Income (MAGI) for most MAGI-based categories and that states may apply a 5% FPL income disregard or use state-specific rules, meaning effective income cutoffs can differ slightly from the headline 138% [3] [4]. The summaries also note that Alaska and Hawaii have separate poverty guidelines, so dollar thresholds are higher in those states even when the percentage of FPL is the same [4].
3. Enrollment and Context: Expansion’s Reach and Reporting Variability
Enrollment data referenced in the analyses report tens of millions of people enrolled in Medicaid and CHIP in 2025, with one summary citing more than 77 million combined enrollees and over 70 million in Medicaid specifically; such scale shows the practical importance of expansion decisions for state programs [7]. The link between expansion status and enrollment growth is implied in the material, but the summaries do not consistently provide state-by-state rollouts or timelines; differences in reporting windows and whether sites report “adopted” versus “implemented” plans produce observable discrepancies in counts and enrollment attribution [7] [1]. Readers should expect variation in state-level guidebooks and eligibility calculators because of these timing and methodology differences [6] [4].
4. Where the Sources Diverge — Methodology and Possible Agendas
The dataset includes both consensus-driven trackers and at least one outlier that reports every state expanded Medicaid and uses atypical monthly dollar figures tied to a Federal Benefit Rate concept; such divergence signals methodological differences or potential misinterpretation of eligibility programs [6]. State-focused eligibility charts and tools provide granular calculators and note local rule exceptions, which can lead to narrower or broader eligibility portrayals depending on whether they incorporate MAGI rules, state waivers, or higher guidelines in Alaska and Hawaii [3] [4]. The presence of multiple counts (38, 41, all states) suggests readers must check the publication date and the operational definition of “expansion” when using these summaries for policy or benefit decisions [3] [1].
5. Bottom Line for Users: Check Your State and the Date
For practical planning, the consistent takeaway across the material is that Medicaid expansion generally uses 138% of the FPL as the baseline eligibility cut-off and that a strong majority of states had adopted expansion by mid-2025, commonly reported as 41 states plus DC, with notable exceptions across analyses [1] [5]. Because individual state guides and eligibility tools apply MAGI calculations, income disregards, and state-specific poverty guidelines, potential applicants must consult their state’s official Medicaid website or an up-to-date eligibility calculator for precise income thresholds and application steps; the summaries make clear that state-level nuance and the timing of reporting can change the practical answer for any given person [3] [4].