Issue Brief | 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

November 30, 2018

New Concepts for Section 1332 Waivers Present Options–and Questions–for States

Following guidance released earlier this fall, on November 29, 2018 the Centers for Medicare & Medicaid Services (CMS) released a discussion paper entitled “Section 1332 State Relief and Empowerment Waiver Concepts” to provide states with additional guidance and information about four types of waiver concepts that could be approved under the earlier guidance. This expert perspective reviews the four waiver concepts proposed in the discussion paper and the potential opportunities they present for states.

November 21, 2018

Proposed Marketplace Program Integrity Rule: Summary and Implications for States

On November 9, 2018, the U.S. Department of Health & Human Services (HHS) published a proposed set of new standards for the Affordable Care Act (ACA) marketplaces. The preamble describes these standards as part of HHS’ efforts to improve marketplace “oversight and financial integrity.” If finalized, they will be effective for the 2020 plan year. HHS is asking for comments on the proposal by January 8, 2019.

August 24, 2018

CMS Issues Additional Guidance on Budget Neutrality for Section 1115 Waivers

On Wednesday, August 22, the Centers for Medicare & Medicaid Services (CMS) released a State Medicaid Director Letter (SMDL) memorializing CMS policy for ensuring that Section 1115 waivers remain budget neutral to the federal government. The SMDL describes CMS policy for calculating budget neutrality both for new waivers and for extensions of existing waivers with the implications for states with existing waivers, and those seeking to apply for waivers, discussed in this expert perspective.