Issue Briefs | May 14, 2018

Medicaid Buy-In: State Options, Design Considerations and Section 1332 Waiver Implications

Patricia Boozang, Chiquita Brooks-LaSure and Ashley Traube, Manatt Health

States continue to identify and pursue strategies to further reduce the number of uninsured, to make coverage more affordable for consumers and to improve access to care. Several proposals have been introduced at both the federal and state levels that would permit people above Medicaid eligibility levels to “buy in” to Medicaid or would leverage the Medicaid program to strengthen coverage across the individual market and Medicaid. This issue brief presents two possible models for a Medicaid buy-in program for states, and details the design considerations and authorities needed to implement each model.

The State Health Policy Highlight, Medicaid Buy-In: What Is It? And How Can It Be Useful to States? provides an overview of the concept of Medicaid buy-in and outlines the issues states can solve for by implementing a Medicaid buy-in program.

State Health and Value Strategies hosted a companion webinar, Medicaid Buy-in: State Options and Design Considerations based on the issue brief that provided an overview on Medicaid buy-in and explored the two models profiled in the issue brief.


Expert Perspectives

January 19, 2021

2022 Notice of Benefit & Payment Parameters: Implications for States

On November 25, 2020, the U.S. Departments of Health & Human Services (HHS) and Treasury released the proposed 2022 “Notice of Benefit & Payment Parameters” (NBPP), the annual rule governing core provisions of the Affordable Care Act (ACA), including the operation of the marketplaces, standards for insurers, and the risk adjustment program. This expert perspective focuses on several provisions that have implications for state oversight of insurance markets and the state-based marketplaces. Comments on the proposed rule are due by December 30, 2020.

The No Surprises Act: Implications for States

In the waning days of 2020, Congress enacted a $900 billion COVID-19 relief package and government funding bill (H.R. 133). Included in the measure is the “No Surprises Act”, which contains new protections for consumers from surprise medical bills from out-of-network providers. The new law establishes, for the first time, comprehensive protections in the states without their own balance billing laws and for the nearly 135 million people in self-insured plans beyond the reach of state regulators. This expert perspective summarizes provisions that have particular implications for state regulators.