Medicaid covers over 70 million Americans, but what it covers for adults depends heavily on the state you live in. In 2025, the biggest differences show up in adult dental/vision, postpartum coverage, behavioral health, long-term care at home, and expansion to low-income adults. Below is a plain-English, state-by-state guide with trusted sources.
Quick answer: What varies in Medicaid by state in 2025?
- Adult dental & vision are optional under federal law, so breadth of coverage ranges from none/emergency-only to comprehensive preventive + restorative benefits. Medicaid+1
- Expansion to low-income adults up to 138% FPL: most states have expanded; a handful still have not. Benefits and eligibility differ accordingly. KFF
- Pregnancy & postpartum: many states now provide 12 months of postpartum coverage; implementation details differ. KFF
- Behavioral health & SUD: covered everywhere, but service scope, delivery, and access vary widely by state. KFF
- Long-term services & supports (LTSS/HCBS): nearly all states run 1915(c) waivers with varying services, caps, and waitlists. Medicaid
Bottom line: The federal floor is consistent, but optional benefits and waivers create real differences across states.
The basics: mandatory vs optional Medicaid benefits
Federal law requires states to cover certain mandatory benefits (e.g., inpatient/outpatient hospital, physician services, labs/X-rays, nursing facility for adults). States may add optional benefits (e.g., adult dental, adult vision, prescription drugs—covered by all states but with different management), personal care, and more. Exact lists and authorities: Medicaid.gov. Medicaid
Source: Medicaid.gov “Mandatory & Optional Medicaid Benefits,” last checked: September 28, 2025. Medicaid
Bottom line: If you’re comparing states, optional categories (dental, vision, HCBS features) drive the biggest differences.
Five big differences to check in your state
1) Medicaid expansion status (adults up to 138% FPL)
As of September 2025, most states and DC have expanded Medicaid to nearly all low-income adults (up to 138% of the Federal Poverty Level), with a higher federal match for that group. Non-expansion states may restrict adult eligibility or use narrower pathways. See KFF’s current map. KFF
- 2025 FPL context comes from HHS/ASPE. States align eligibility thresholds to these numbers. ASPE
Bottom line: Expansion generally means broader adult eligibility and more consistent benefits; non-expansion states can have gaps.
2) Adult dental & vision benefits
Adult dental coverage varies from emergency-only to extensive preventive + restorative care. As of Dec 31, 2024 (latest full review), 11 states + DC offered extensive adult dental (e.g., Alaska, Iowa, Maine, Minnesota, Montana, Nebraska, New Jersey, Oregon, Tennessee, West Virginia, Wisconsin) with momentum continuing into 2025; other states offer limited or emergency-only. CareQuest Institute
Budget pressures can trigger cuts to optional adult dental benefits, which research links to higher ER use for dental crises. Commonwealth Fund
Adult vision is also optional; many states provide at least periodic exams/eyeglasses, but scope varies. (See Medicaid.gov optional benefit list.) Medicaid
Bottom line: Check your plan’s adult dental/vision schedule and annual caps; coverage levels differ markedly by state.
3) Pregnancy & 12-month postpartum coverage
Since ARPA 2021, states could extend Medicaid postpartum to 12 months; by January 2025, most states (48 + DC) had adopted or implemented it, though start dates and exact parameters differ. Track your state on KFF’s Postpartum Coverage Extension Tracker. KFF+1
Bottom line: In 2025, 12-month postpartum is close to universal, but effective dates and specifics still vary—verify locally.
4) Behavioral health & substance use disorder (SUD) services
All states cover medically necessary behavioral health care, but service arrays, settings (e.g., IMD waivers), and delivery models show wide state-level variation. KFF’s analyses document substantial differences in access and treatment rates across states for specific SUD services. KFF
Bottom line: Coverage exists everywhere, but what’s covered, where, and how easily accessed depends on your state’s policies and workforce.
5) Long-term services & supports (HCBS)
Nearly all states operate 1915(c) HCBS waivers so people can receive long-term care at home or in the community instead of institutions. Services, budgets, and waitlists differ widely; 47 states + DC run at least one 1915(c) waiver, alongside other HCBS authorities. Medicaid
Bottom line: Eligibility and waitlists for home-based long-term care are state-specific—check your waiver(s) directly.
2025 state snapshots (illustrative comparison)
Use this quick-glance table to see how selected states compare on four hot-button differences. Always verify details with your state Medicaid agency or plan.
| State | Expansion to 138% FPL | Adult Dental (directional) | Postpartum 12-month | Notable Waiver/Policy Note |
|---|---|---|---|---|
| California | Yes | Robust/expanded historically | Implemented | Multiple HCBS waivers; broad behavioral health reforms (see state resources). Medicaid |
| New York | Yes | Includes preventive/restorative | Implemented (state notices) | HCBS & managed care waivers; active 1115. Medicaid |
| Florida | No (as of 9/2025) | Limited adult dental | Implemented (tracker) | 1115 waivers shape benefits/delivery. KFF+1 |
| Texas | No | Limited adult dental | Implemented (tracker) | Funding/financing rules in flux after recent court ruling affecting CMS tax-funding rule scope (general context). Reuters |
| Georgia | Partial (Pathways w/ work reqs) | Limited adult dental | Implemented (tracker) | Work-requirement program extended through Dec 2026 with tweaks. AP News |
| Tennessee | Yes | Extensive adult dental | Implemented | Uses 1115 for broader flexibilities. CareQuest Institute+1 |
| Wisconsin | No full ACA expansion | Extensive adult dental | Implemented | Unique eligibility up to 100% FPL adults; HCBS waivers active. CareQuest Institute+2KFF+2 |
| Oregon | Yes | Extensive adult dental | Implemented | 1115 waiver for continuous coverage innovations. CareQuest Institute+1 |
| New Jersey | Yes | Extensive adult dental | Implemented | 1115 Demonstration; robust HCBS. CareQuest Institute+1 |
| Nebraska | Yes | Moderate-to-broad | Implemented (recent expansion move) | Expansion + postpartum extension emphasis. AP News |
Directional dental levels reflect statewide policy posture (extensive vs limited vs emergency-only) based on the latest comparative summaries; always confirm your specific plan and service caps. CareQuest Institute
Bottom line: Even among expansion states, adult dental scope and HCBS access can make two states feel very different.
Income limits in 2025: how states apply FPL
States set eligibility using 2025 HHS poverty guidelines (e.g., thresholds for household size), and KFF publishes percent-of-FPL cut-offs by state and eligibility group. For seniors needing LTC, specialized income/resource limits apply and vary by state. ASPE+2KFF+2
Source: HHS/ASPE 2025 Poverty Guidelines; KFF eligibility indicators; MedicaidPlanningAssistance senior LTC chart; last checked: September 28, 2025. ASPE+2KFF+2
Bottom line: Your household size, age/disability status, and pathway (MAGI vs ABD/LTSS) determine which state income/resource rules apply.
How to verify your exact benefits (checklist)
Use this 7-step checklist to confirm what you get in your state:
- Confirm expansion status on KFF’s map. If non-expansion, look for limited adult pathways. KFF
- Check postpartum coverage (if pregnant/recently postpartum) on KFF’s tracker and your state site. KFF
- Look up adult dental/vision on your state Medicaid site; compare against national summaries (CareQuest/Commonwealth Fund notes on cuts). CareQuest Institute+1
- Review behavioral health benefits (SUD services list, prior auth rules). KFF’s SUD analyses show what to expect. KFF
- If you need long-term care at home, find your 1915(c) waiver name and read its service/cap rules on Medicaid.gov. Medicaid
- Use current FPL numbers to gauge eligibility; then verify state-specific income/resource limits for your category. ASPE+2KFF+2
- Check active 1115 waivers (work requirements, continuous eligibility pilots, social supports) on KFF’s waiver tracker and Medicaid.gov. KFF+1
Bottom line: Start with KFF + Medicaid.gov, then drill into your state’s official Medicaid page for the fine print.
Waivers & special rules to watch in 2025
- 1115 waivers can alter eligibility, benefits, and delivery (e.g., continuous coverage pilots, SDOH services, or—rarely—work requirements). Use KFF’s Waiver Tracker and Medicaid.gov’s waivers list. KFF+1
- Georgia’s “Pathways to Coverage” remains an outlier: partial expansion tied to monthly activity (80 hours) with administrative simplifications in 2025 and an extension to December 2026. AP News
- Financing rules occasionally shift via regulation/litigation; a recent Texas case struck down a CMS rule on Medicaid tax funding methodologies with potential nationwide implications. Monitor state guidance. Reuters
Bottom line: 1115 and financing changes can meaningfully reshape how Medicaid works in your state—keep an eye on state notices.
Disclaimer
This article is general information, not legal, financial, or medical advice. Medicaid rules change and may be applied differently by each state and plan. Always confirm with your state Medicaid agency or your health plan before making decisions.
FAQs
1) Which states have the most comprehensive Medicaid adult dental benefits in 2025?
As of 12/31/2024 reviews used for 2025 planning, 11 states + DC met “extensive” adult dental criteria (e.g., AK, IA, ME, MN, MT, NE, NJ, OR, TN, WV, WI); other states offer limited or emergency-only. Always check your state site for updates. CareQuest Institute
2) Did my state expand Medicaid to low-income adults up to 138% FPL?
See KFF’s Status of State Medicaid Expansion Decisions map, updated September 12, 2025. KFF
3) Do all states now offer 12 months of postpartum Medicaid?
Nearly all do as of early 2025; check KFF’s Postpartum Coverage Extension Tracker for your state’s dates and details. KFF
4) Are adult vision exams and eyeglasses covered?
Adult vision is optional. Many states offer some coverage (exams/eyewear) but limits vary. Verify with your plan. Medicaid
5) What behavioral health/SUD services can vary by state?
Coverage scope (e.g., MAT, peer supports, residential options via IMD waivers), provider networks, and prior auth rules. KFF shows large state variation in treatment rates. KFF
6) How do HCBS waivers change my benefits?
1915(c) waivers let states fund home/community-based long-term services. Service menus, caps, and waitlists are state-specific. Medicaid
7) What income counts for Medicaid in 2025?
States base thresholds on 2025 HHS poverty guidelines and program category (MAGI vs ABD). See ASPE and KFF indicators; seniors needing LTC face different income/resource tests. ASPE+2KFF+2
8) Why is Georgia different?
Georgia operates a partial expansion with a work-requirement pathway (“Pathways”) now extended through Dec 2026 with some administrative easing. AP News
“Source:” callouts for sensitive facts
- Mandatory vs optional benefits: Source: Medicaid.gov, last checked: September 28, 2025. Medicaid
- Expansion status: Source: KFF Expansion Decisions Map (updated Sep 12, 2025), last checked: September 28, 2025. KFF
- FPL context: Source: HHS/ASPE 2025 Poverty Guidelines, last checked: September 28, 2025. ASPE
- Adult dental landscape: Source: CareQuest 2024 year-end analysis, last checked: September 28, 2025; Commonwealth Fund explainer on budget-driven dental changes, last checked: September 28, 2025. CareQuest Institute+1
- Postpartum extension prevalence: Source: KFF Postpartum Extension Tracker; Georgetown CCF 2025 summary, last checked: September 28, 2025. KFF+1
- Waivers & special rules: Source: KFF 1115 Waiver Tracker; Medicaid.gov Waivers List; AP coverage of GA Pathways extension, last checked: September 28, 2025. KFF+2Medicaid+2
Key takeaways & next steps
Takeaways (3–5):
- Optional benefits (adult dental/vision, certain behavioral health features, HCBS) = biggest state-by-state differences. Medicaid
- Most states have expanded Medicaid and extended postpartum to 12 months, but implementation details matter. KFF+1
- Waivers (1115/1915) drive real differences—check your state’s. KFF+1
- Use 2025 FPL to estimate eligibility; seniors needing LTC face distinct rules. ASPE+1
Next steps:
- Open the KFF expansion and postpartum trackers for your state. KFF+1
- Check adult dental/vision on your state Medicaid site; confirm annual caps/limits. CareQuest Institute
- If you need LTSS at home, read your 1915(c) waiver page on Medicaid.gov. Medicaid