Jun, 04, 2019

Map: State Efforts to Develop Medicaid Buy-In Programs

Heather Howard

In the absence of federal legislation to stabilize the individual market, states are examining strategies to strengthen their marketplaces and maintain coverage gains. In recent months, states have increasingly introduced proposals for individuals above Medicaid eligibility levels to “buy-in” to Medicaid (leverage the Medicaid program in some way) or develop a “public option to strengthen coverage across the individual market and Medicaid. These Medicaid buy-in or public option programs offer states an opportunity to make coverage more affordable and accessible in their state.

We have mapped out current legislative state activity and included links to relevant legislation. You’ll see that several states are actively pursuing the development of a program and a few are establishing task forces or study groups to understand the impacts of such a program on health care access and cost in their state.

In addition to the map, State Health and Value Strategies (SHVS) published an issue brief, authored by Manatt Health, highlighting state options, design considerations, and section 1332 waiver implications for states considering Medicaid buy-in programs.

Last year, SHVS, with technical experts from Manatt Health, hosted a webinar based on the issue brief and highlighted the central considerations that a state must take into account when developing a Medicaid buy-in proposal; the primary models for state-administered Medicaid buy-in proposals; and the administrative considerations and authorities needed for each model. The webinar also highlighted current state models to develop buy-in proposals. On December 17, 2018 SHVS and Manatt Health held another webinar focusing on evolving state models and considerations, including potential pass through funding mechanisms and how the latest federal 1332 guidance plays into potential Medicaid buy-in proposals.

Most recently, SHVS and Manatt Health released an issue brief and hosted a companion webinar on April 25 on the key questions that states pursuing these initiatives will want to consider as they seek to design and implement their proposals.

In several states, studies have been published about what a Medicaid buy-in proposal may look like. As additional reports are published, we will post them here.

Public Option/ Medicaid Buy-in Plan Legislation Passed



Buy-In/Public Option Plan Proposed [Active Legislation]


Legislation  Legislation

New Jersey

Legislation Legislation


Legislation  Legislation  Legislation

Task Force Study Group Established Legislatively


Legislation Legislation







New Mexico

Legislation Legislation

Task Force Study Group Proposed [Active Legislation]