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2025 Update: New Medicaid Expansion States (None)

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Short version: No state newly adopted Medicaid expansion in 2025. The national count remains 41 states (including DC) expanded, 10 not. But 2025 still brought policy shifts, updated FPL numbers, and growing pressure in several holdouts. Below: the current map, what changed, and how to prepare. KFF

Quick answer—any new expansion states in 2025?

No. As of September 2025, no U.S. state newly expanded Medicaid this year. KFF’s latest map confirms 41 states (including DC) adopted and 10 states have not. KFF
Source: KFF Status of State Medicaid Expansion Decisions, last checked: September 17, 2025.

Bottom line: 2025 brought no new adoptions—but momentum and policy changes still matter for residents in holdout states.

The 2025 map at a glance

Where expansion stands

  • Expanded: 41 states (including DC).
  • Not expanded (10): Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming. KFF+1
    Source: KFF & Stateline, last checked: September 17, 2025.

Notes:

  • Georgia runs Pathways to Coverage (a partial pathway with work/“qualifying activities” and income up to 100% FPL). This is not full ACA expansion to 138% FPL. Georgia Pathways to Coverage+1
  • Wisconsin covers many childless adults to 100% FPL via waiver, but has not adopted full ACA expansion (therefore not receiving the 90% enhanced match for the expansion group). Wisconsin Department of Health Services+1

Bottom line: The holdout list is unchanged in 2025. Two states operate non-standard approaches (GA partial + WI to 100% FPL).

What changed in 2025 (policy & numbers you should know)

  1. Federal policy: work-requirement provisions.
    In July 2025, Congress passed a broad budget law with work-requirement provisions for expansion adults (implementation details and timelines still unfolding). KFF’s analysis outlines the 80 hours/month standard and exemptions; states and CMS are working through rule-making/waiver alignment. Watch your state Medicaid site for timing. KFF
    Source: KFF, last checked: September 17, 2025.
  2. 2025 FPL (poverty guidelines).
    Medicaid income thresholds are tied to HHS poverty guidelines. For 2025, 100% FPL for a household of 1 in the contiguous U.S. is $15,650; 138% FPL (the ACA expansion standard) equates to ~$21,597 annual income for one person. ASPE+1
    Source: HHS/ASPE & KFF, last checked: September 17, 2025.
  3. Enrollment context (unwinding).
    As states continue post-pandemic Medicaid unwinding, CMS and KFF trackers show May 2025 national Medicaid/CHIP enrollment around 78.1 million (70.8M Medicaid; 7.27M CHIP). Check your state’s site for current reenrollment rules. Medicaid+1
    Source: Medicaid.gov & KFF, last checked: September 17, 2025.

Bottom line: Even without new adoptions, rules and numbers moved in 2025—especially around work requirements and FPL thresholds.

Georgia Pathways vs full ACA expansion (what’s the difference?)

Georgia Pathways (1115 waiver):

  • Who: Adults 19–64, ≤100% FPL, not otherwise eligible.
  • Extra step: Must complete ≥80 hours/month of “qualifying activities” (work, school, volunteering, etc.).
  • Status: Active; unique in the nation for using a work requirement as a coverage gate in 2025. Georgia Pathways to Coverage+2Georgia Pathways to Coverage+2
    Source: Georgia Pathways & policy memo, last checked: September 17, 2025.

ACA expansion (standard):

  • Who: Nearly all non-elderly adults up to 138% FPL (MAGI rules).
  • No work requirement gate to qualify; 90% federal match for the expansion population. NCSL

Why it matters:

  • Eligibility width: ACA expansion reaches to 138% FPL; Pathways stops at 100% FPL.
  • Administrative friction: Work-reporting increases the risk of churn/coverage loss even for eligible people.
  • Federal funding: Full expansion states receive a higher federal share for the expansion group.

Bottom line: Pathways ≠ expansion. It covers fewer people, with more hoops, and lacks the standard 90% match for the expansion group. Georgia Pathways to Coverage+1

Comparison table: Full ACA expansion vs partial/waiver models (2025)

FeatureFull ACA ExpansionGeorgia Pathways (partial)
Income limit (adults)≤138% FPL (MAGI)≤100% FPL
Work/“qualifying activities” requirementNoYes – ≥80 hours/month
Federal match (expansion adults)90% (enhanced)Standard/waiver terms (no ACA enhanced match for 100% FPL group)
Continuous eligibility featuresVaries by state; not contingent on work reportsCoverage contingent on documented hours
Who’s helped mostAdults 100–138% FPL & those with unstable work hoursAdults ≤100% FPL who can meet monthly reporting
Status in 202541 states + DCGA only (unique nationally)

Sources: NCSL overview; Georgia Pathways site; KFF policy analysis—work-requirement provisions in 2025. Last checked: September 17, 2025. NCSL+2Georgia Pathways to Coverage+2

Bottom line: Full expansion is broader and simpler; partial models are narrower and higher-friction.

If your state expands next—how to get covered fast (checklist)

Pre-enrollment prep (do this now, even before any law passes):

  • Create a secure email and save your passwords; you’ll use this for your state Medicaid account.
  • Gather identity docs: photo ID, SSN, proof of residency (lease/utility), and citizenship/immigration documents if applicable.
  • Pull household income proofs for the last 30–60 days (pay stubs or a self-attestation form if you’re newly unemployed).
  • Know your household size (IRS tax household for MAGI).
  • If you have kids, find their birth certificates and school/enrollment info (often requested).
  • Bookmark your state Medicaid site + HealthCare.gov in case the state uses the Marketplace as a front door. HealthCare.gov

When expansion (or new eligibility) goes live:

  • Apply online on Day 1; submit all verifications promptly to avoid pending/denials.
  • Check notices weekly; respond to requests by the listed deadline.
  • If denied for procedural reasons (missing docs), reapply or appeal quickly—procedural denials are common during big rollouts. Medicaid

Bottom line: Having documents ready can turn a weeks-long application into a same-week approval once expansion launches.

State watchlist: who tried in 2025—and what happened

  • Kansas: 2025 session ended without expansion; advocacy continues. ACS CAN
  • Mississippi: 2025 session ended without expansion after competing proposals stalled. ACS CAN+1
  • Wisconsin: Continues partial coverage to 100% FPL (no enhanced match); state debates continue amid federal policy shifts. WPR

Bottom line: Political momentum varies, but Kansas and Mississippi remain the most closely watched for 2026.

FAQs

Did any states newly expand Medicaid in 2025?
No. The count remains 41 states (incl. DC) expanded; 10 not as of Sept 2025. KFF

Which states have not expanded Medicaid in 2025?
AL, FL, GA, KS, MS, SC, TN, TX, WI, WY. KFF+1

Is Georgia’s Pathways the same as Medicaid expansion?
No. Pathways covers adults ≤100% FPL and requires 80 hours/month of qualifying activities; ACA expansion goes to 138% FPL with no work-gate. Georgia Pathways to Coverage+1

What are the 2025 income numbers used for eligibility?
HHS 2025 poverty guidelines set 100% FPL for one person at $15,650; 138% FPL ≈ $21,597. Alaska/Hawai‘i differ. ASPE

What changed federally in 2025 for expansion adults?
A new budget law includes work-requirement provisions (e.g., 80 hours/month standard) with implementation details pending. KFF

How many people are on Medicaid/CHIP right now?
About 78.1 million (May 2025 prelim): 70.8M Medicaid, 7.27M CHIP. Medicaid

Credits, sources & disclaimers

  • Status map & counts: KFF Status of State Medicaid Expansion Decisions, published Sept 12, 2025 (41 expanded incl. DC; 10 not). Source: KFF, last checked: Sept 17, 2025. KFF
  • Holdout list corroboration: Stateline (Pew). Source: Stateline, last checked: Sept 17, 2025. Stateline
  • Georgia Pathways (eligibility & hours): Georgia official site; policy memo. Source: pathways.georgia.gov; GHF memo, last checked: Sept 17, 2025. Georgia Pathways to Coverage+1
  • FPL 2025: HHS/ASPE poverty guidelines PDF. Source: ASPE, last checked: Sept 17, 2025. ASPE
  • 2025 work-requirement provisions: KFF analysis of the 2025 budget law. Source: KFF, last checked: Sept 17, 2025. KFF
  • Enrollment context: Medicaid.gov highlights & KFF Unwinding Tracker. Source: CMS/Medicaid & KFF, last checked: Sept 17, 2025. Medicaid+1

Disclaimer: This article is general information, not legal, tax, or benefits advice. Policies change. Always confirm your eligibility and application steps with your state Medicaid agency or a qualified assister/navigator.

Key takeaways & next steps

Takeaways

  1. No new expansion states in 2025; the map remains 41 (incl. DC) vs 10. KFF
  2. Georgia Pathways is not full expansion (≤100% FPL + 80-hour requirement). Georgia Pathways to Coverage
  3. 2025 FPL & policy changes matter for eligibility and administration (watch for work-rule timelines). ASPE+1
  4. If your state is a holdout, prep documents now to file fast if expansion passes. HealthCare.gov

Next steps

  • Check your state Medicaid site and sign up for updates.
  • If you’re in a holdout state, save ID/income docs and build a my account on the state portal (if available).
  • Need help? Contact a local navigator/assister via HealthCare.gov. HealthCare.gov

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