The 2016 edition of the Interstate standards uses the word should for median width, but shall for other criteria such as shoulders and unit lane width, which suggests to me that there is more leeway for medians.
There definitely is. Texas seems to either use 48 foot for standard median width on new construction (some exceptions do exist with wider), or a concrete barrier only (narrow median).
North Carolina uses 46 foot median for the most part, including over 100 miles of I-40 built between Raleigh and Wilmington in the 1980s. Even the newer addition freeways have areas with 46 foot median. There’s nothing wrong with it.
I wouldn’t advise narrow medians on new construction, but incorporating an older freeway segment with a narrow median (after installing cable barrier at the minimum) that meets interstate standards otherwise (full access control, full paved shoulders, etc.) should be, and is allowed.
Kentucky’s segments of I-69 along the existing parkways have a 35 foot median I believe, and they’ve all been incorporated. There wasn’t even a cable barrier installed in most places. I believe from a safety standpoint, those should be incorporated regardless of standards or not. You have two dual roadways with opposing 70+ mph traffic that close, there ought to be a barrier.