| Apr 22, 2019

State Medicaid Buy-Ins: Key Questions to Consider

Patricia Boozang, Chiquita Brooks-LaSure, and Kyla Ellis, Manatt Health

Lawmakers across the country are considering Medicaid buy-in programs to stabilize the Affordable Care Act insurance market and offer a coverage option that is more affordable and accessible than current options in the individual and employer markets. The concept of Medicaid buy-in is evolving, encompassing the original Medicaid-based proposals and extending to other programs through which the state can leverage its government bargaining power to offer a more affordable coverage option, like state employee health plans or a Basic Health Plans. Some refer to this evolving model as Medicaid buy-in, while others label it a “public option,” particularly for state-sponsored plans in the marketplace.

So far in the 2019 legislative session, more than 10 states have introduced legislation to study or implement a buy-in. The purpose of this issue brief is to identify the key questions that states pursuing these initiatives will want to consider as they seek to design and implement their proposals.

The State Health Policy Highlight, State Considerations for Medicaid Buy-In Proposals, provides a checklist summarizing the key questions, which are laid out in greater detail in the underlying issue brief.

For more information, visit State Health and Value Strategies’ (SHVS) webpage tracking state activity around Medicaid buy-in/public option proposals and linking to other SHVS resources.


Expert Perspectives

November 18, 2019

Standardizing Health Plan Benefit Design: Opportunities and Implications for States

Sabrina Corlette, Georgetown University Center on Health Insurance Reforms

In 2019, the Washington legislature enacted a bill requiring insurers on the state’s health insurance exchange to offer plans with standardized benefit designs, beginning in 2021. Colorado and Maryland are considering similar requirements. As these and other states consider the option of standardized health plans, they can benefit from the experiences of California, the District of Columbia (D.C.), Connecticut, Massachusetts, New York, Oregon, and Vermont, all of which require insurers to offer standardized benefit designs. This Expert Perspective outlines benefits and risks of plan standardization, and raises critical questions that states will need to consider, and offers a decision roadmap for states implementing a standardized benefit design requirement.

January 13, 2020

More States Looking to Section 1332 Waivers

In the absence of federal legislation, states are actively seeking tools to reform their health care systems. While 1115 waivers rightly get a lot of attention, because of their ability to reshape state Medicaid programs, the Affordable Care Act’s Section 1332 waivers continue to be a promising avenue for states to stabilize their health insurance marketplace. SHVS is tracking state activity and has many resources, including a template, for states interested in pursuing a Section 1332 waiver.

More information

October 18, 2019

New Policy Regarding Uninsured Noncitizens

On October 4, the President issued a proclamation that requires immigrants to show that they have health insurance or can pay medical expenses out of pocket in order to receive a visa. The proclamation will impact individuals applying for a visa with the Department of State (DOS) through consular offices abroad. In this expert perspective, Manatt Health reviews this latest policy regarding uninsured noncitizens and provides their take on implications for states.