Expand Access to Affordable Healthcare through a Medicaid Buy-in Plan

More than half of U.S. adults don’t have access to affordable healthcare. And in 35% of U.S. counties, only one company offers any type of health insurance for the millions of Americans not covered by their employer. But there are existing, workable solutions to expand access to healthcare. Medicaid “buy-in” allows families and individuals not otherwise eligible for Medicaid the chance to “buy-in” to Medicaid as an insurance plan. It’s a universal, affordable option for those who don’t have one. And, in the third of counties that leave people with no choice at all, it can help bring down costs for everyone by breaking the health insurance providers’ monopoly.

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Frequently Asked Questions
Who does this help?
This helps families without adequate healthcare options by giving them the choice to enroll in a more affordable health insurance plan. And, by providing a second option in communities where only one insurer currently offers purchasable coverage, a Medicaid buy-in plan can lower rates and costs across the board.
Is this affordable for the state?
Yes. Existing systems and structures make Medicaid buy-in an efficient option to provide an additional, affordable coverage option to residents, who would pay premiums. Research shows that when more residents have access to health coverage, states save money in the long term through reduced emergency and intervention services and improved health outcomes.
  • Patient and consumer advocacy groups
  • Hospitals and healthcare providers
  • Small businesses
  • Opponents of Social Security, Medicare and Medicaid
  • Health insurance companies that benefit from a lack of choice
Model Policy
This act shall be known as the Medicaid Buy-In Act
This act establishes a Medicaid buy-in program to provide residents with a choice of quality, affordable health insurance.

(a) Within 1 year of the effective date, DEPARTMENT shall establish a Medicaid buy-in plan and shall offer the buy-in plan for purchase by a resident:
-(i) Who is ineligible for the following:
–(1) Medicaid;
–(2) Medicare; and
–(3) Advance premium tax credits under the federal Patient Protection and Affordable Care Act; and
-(ii) Whose employer has not disenrolled or denied the resident enrollment in employer-sponsored health insurance coverage on the basis that the resident would otherwise quality for enrollment in Medicaid buy-in coverage.

(b) Enrollment in the Medicaid buy-in plan shall comply with nondiscrimination laws set forth in STATE and shall be available to residents irrespective of age, race, gender, national origin, immigration status, disability or geographic location.

(c) The DEPARTMENT shall establish benefits under the medicaid buy-in plan in accordance with federal and STATE law to ensure that covered benefits include:
-(i) Ambulatory patient services;
-(ii) Emergency services;
-(iii) Hospitalizations;
-(iv) Maternity and newborn care;
-(v) Mental health and substance use disorder treatment and services, including behavioral health treatment;
-(vi) Prescription drugs;
-(vii) Rehabilitative and habilitative services and devices;
-(viii) Laboratory services;
-(ix) Preventive and wellness services;
-(x) Pediatric services, including oral and vision care.

(d) The DEPARTMENT shall pursue any available federal funding and financial participation for the services and benefits provided.

(e) The DEPARTMENT shall coordinate Medicaid buy-in plan enrollment and eligibility to maximize continuity of coverage between Medicaid buy-in plans, traditional Medicaid, and private health insurance.

(f) Healthcare provider reimbursement rates shall be based on the STATE Medicaid fee schedule.
-(i) Contingent upon available funds, the department may increase reimbursement rates for healthcare providers, only if these increases do not negatively impact the sustainability of the Medicaid buy-in plan or Medicaid.

(g) The DEPARTMENT shall coordinate with other relevant agencies to establish:
-(i) A system under which residents apply for enrollment in, receive a determination of eligibility for participation in, renew participation in the Medicaid buy-in plan; and
-(ii) A consumer outreach program to increase awareness of the Medicaid buy-in plan and assist residents with enrolling in Medicaid, the Medicaid buy-in plan and/or other qualified health plans offered by the STATE exchange.