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.
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.
In recent months, states have increasingly introduced proposals for individuals above Medicaid eligibility levels to “buy-in” to Medicaid or leverage the Medicaid program to strengthen coverage across the individual market and Medicaid. State Health and Value Strategies is tracking current state activity and has mapped out which states are pursuing a program and those that are establishing task forces to understand the impact of a Medicaid buy-in program.
On March 27, for the second time, a federal judge vacated the Centers for Medicare & Medicaid Services (CMS) approval of Kentucky’s Medicaid 1115 demonstration waiver to test, among other things, a work requirement as a condition of Medicaid eligibility. In a related case of Arkansas’s Medicaid work requirements demonstration, the judge likewise vacated the federal approval, remanding it to CMS for further consideration. Notably, because Arkansas, unlike Kentucky, had already implemented the work requirements, the decision requires the state to cease its work requirement and related Medicaid disenrollments. This expert perspective reviews the court’s decision and its implications for both Kentucky and Arkansas and other states with similar approved or pending waiver requests, as well as for states contemplating imposing work or other “community engagement” requirements on Medicaid beneficiaries.
