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.

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