Medicaid Buy-in: State Options, Design Considerations and 1332 Implications

Prepared for Robert Wood Johnson Foundation’s State Health & Value Strategies program

During the open enrollment period for the 2018 plan year, approximately 11.8 million people enrolled in marketplace coverage and 74 million people enrolled in Medicaid, bringing the United States’ uninsured rate to 12.2 million. States continue to identify and pursue strategies to further reduce the numbers of uninsured, to make coverage more affordable for consumers and to improve access to care. In the absence of federal legislation to stabilize the individual market, states are seeking options to strengthen their marketplaces and maintain coverage gains. In recent months, 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.

In an issue brief prepared for the Robert Wood Johnson Foundation’s State Health & Value Strategies program, the Manatt team describes the central considerations that a state must take into account when developing a Medicaid buy-in proposal, including its primary policy goals. The issues brief also discusses the primary models for state-administered Medicaid buy-in proposals and the administrative considerations and authorities needed for each model. Finally, for those Medicaid buy-in proposals that will require approval of a state innovation waiver under Section 1332 of the Affordable Care Act, the paper examines Section 1332 deficit neutrality, as well as pass-through funding implications that states will want to consider as they craft their buy-in proposals.

Click here to read the full issue brief.