The Federal Baseline:

138% of the Federal Poverty Level

Under the Affordable Care Act (ACA), states that expanded Medicaid must cover adults up to 138% of the Federal Poverty Level (FPL) . For 2025, the U.S. Department of Health and Human Services has set the poverty guidelines as follows:

,060 per year

,783 per year (approximately ,732 per month)

This means that in expansion states, a single adult earning up to ,783 annually (before taxes) qualifies for Medicaid. It is important to note that this figure applies to modified adjusted gross income (MAGI) , which includes wages, Social Security benefits, and certain other income sources, but excludes items like Supplemental Security Income (SSI) in some cases.

State-by-State Variations

While the 138% FPL threshold is the federal benchmark, states have flexibility in setting their own limits. Below is a breakdown by state category:

1. Medicaid Expansion States (40 States + D.C.)
These states have adopted the ACA expansion and generally follow the 138% FPL rule. However, a few add modest income disregards or work requirements, which can effectively lower or raise the threshold. For example:

138% FPL (,783) – no additional disregards.

138% FPL – but with a special “Medicaid Buy-In” for working disabled adults up to 250% FPL.

138% FPL – but with a work requirement (currently waived during the public health emergency, but may be reinstated).

138% FPL – but only after the state’s waiver for a 100% FPL cap for certain childless adults expires in 2025.

2. Non-Expansion States (10 States)
As of 2025, the following states have not expanded Medicaid: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. In these states, childless, non-disabled adults generally do not qualify for Medicaid at all, regardless of income, unless they are pregnant, elderly, or disabled.

Wisconsin covers childless adults up to 100% FPL (,060) through a state-funded waiver, but this is not full expansion.

Georgia’s “Pathways to Coverage” program covers adults up to 100% FPL, but only if they meet strict work/reporting requirements (at least 80 hours/month of work or community engagement). Enrollment is capped.

3. States with Higher Limits for Special Populations
Even in expansion states, certain single adults may qualify with higher incomes if they are:

(as defined by the state) – often up to 150% FPL.

– up to 250% FPL in many states.

(up to age 26) – no income limit in many states.

How Income Is Counted

Medicaid uses MAGI for most applicants. Key rules include:

Wages, self-employment net income, unemployment benefits, Social Security (except SSI), pensions, and interest/dividends.

SSI payments, child support, gifts, and most retirement account withdrawals (if not regular).

A 5% income disregard is applied automatically in expansion states, effectively raising the limit to 143% FPL for calculation purposes. For 2025, this equates to approximately ,538 per year.

Important Caveats

Most expansion states do not apply an asset test for MAGI-based eligibility. However, if you are over 65, blind, or disabled, you may be subject to the traditional Medicaid rules, which include asset limits (e.g., ,000 in countable resources in most states).

Income is generally evaluated on a monthly basis, but you can qualify if your annual income is below the threshold even if some months are higher (e.g., seasonal workers).

No major federal changes to the 138% FPL threshold are expected in 2025. However, states may adjust their own rules through waivers. For example, Arkansas and Nebraska have proposed work requirements that could affect eligibility if approved.

If your income is slightly above the Medicaid limit, you may qualify for subsidized Marketplace plans (with premiums reduced to in many cases) or Basic Health Programs in states like Minnesota and New York.

How to Apply

Apply through your state’s Medicaid agency or the Health Insurance Marketplace at HealthCare.gov.

You may only qualify if you fall into a special category (pregnancy, disability, etc.). If not, explore Marketplace subsidies.

Conclusion

For 2025, the effective Medicaid income limit for single adults in expansion states is ,783 per year (or about ,538 after the 5% disregard). However, your actual eligibility depends heavily on your state of residence and personal circumstances. If you are a single adult without children, check your state’s specific rules first—especially if you live in a non-expansion state, where coverage may be unavailable regardless of income. Always consult your state’s Medicaid office or a certified enrollment counselor for the most accurate, personalized guidance.

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*Note: Figures are based on the 2025 Federal Poverty Guidelines published in January 2025. States may update their limits mid-year; verify with official sources before applying.*