S 489 — State Public Option Act

Summary

State Public Option Act This bill allows residents who are not already eligible for Medicaid and not concurrently enrolled in other health insurance coverage to buy into a state Medicaid plan beginning January 1, 2020, at the option of the state. State Medicaid programs may set premiums and cost-sharing requirements for such coverage in accordance with specified limitations. The bill also (1) provides the enhanced Federal Medical Assistance Percentage (FMAP) to every state that expands Medicaid coverage for individuals who are newly eligible under the Patient Protection and Affordable Care Act, regardless of when such expansion takes place; and (2) requires state Medicaid programs to cover comprehensive reproductive health care services, including abortion services.

Bill Text

• Introduced Introduced in Senate Current html February 14, 2019

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill introduces a Medicaid buy-in option, allowing individuals not concurrently enrolled in another health insurance plan to access Medicaid coverage for a premium.

• 42 U.S.C. 1396a

  none → beginning January 1, 2020, who are residents of the State and are not concurrently enrolled in another health insurance coverage plan, subject, in the case of individuals described in subsection (qq) and notwithstanding section 1916 (except for subsection (k) of such section), to payment of premiums or other cost-sharing charges;

  Creates a new eligibility category for individuals to enroll in Medicaid if they are not covered by another insurance plan.

• 42 U.S.C. 1396a

  none → Individuals described in this subsection are individuals who are— (1) described in subclause (XXIII) of subsection (a)(10)(A)(ii); and (2) are not described in any other subclause of such subsection or any other provision in this Act which provides for eligibility for medical assistance.

  Defines 'previously undescribed individuals' eligible for Medicaid buy-in.

• 42 U.S.C. 1396a(k)(1)

  none → or an individual described in subsection (qq)

  Includes individuals eligible under the new buy-in category in the minimum coverage requirements.

• 42 U.S.C. 1396b(i)(26)

  individuals described in subclause (VIII) of subsection (a)(10)(A)(i) → individuals described in subsection (a)(10)(A)(i)(VIII) or (qq) of section 1902

  Clarifies the federal financial participation criteria to include new buy-in individuals.

• 42 U.S.C. 1396b(a)

  none → an amount equal to 90 percent of the sums expended during such quarter which are attributable to reasonable administrative expenses related to the administration of a Medicaid buy-in program for individuals described in section 1902(a)(10)(A)(ii)(XXIII); plus

  Provides enhanced federal matching funds for administrative expenses related to the Medicaid buy-in program.

• 42 U.S.C. 1396o

  none → with respect to individuals who are eligible for medical assistance under subsection (a)(10)(A)(ii)(XXIII) of section 1902 and are described in subsection (qq) of such section, a State may-- (A) impose premiums, deductibles, cost-sharing, or other similar charges that are actuarially fair;

  Allows states to impose cost-sharing requirements on new buy-in Medicaid participants.

• 42 U.S.C. 1396o(k)

  none → Premiums and Cost-Sharing for Individuals Participating in Medicaid Buy-In Program.

  Establishes specific cost-sharing parameters for individuals in the Medicaid buy-in program.

• 42 U.S.C. 1396u-2(a)(1)(A)(i)

  none → , including an individual who is eligible for such assistance after buying into such coverage under section 1902(a)(10)(A)(ii)(XXIII),

  Incorporates individuals who buy into Medicaid coverage into managed care provisions.

• 42 U.S.C. 1396o

  none → and may impose premiums and cost-sharing on the individual to the extent allowed by another provision of this Act (other than section 1902(a)(10)(A)(ii)(XXIII)) which provides for eligibility for medical assistance, but only if the individual is described in such other provision.

  Clarifies cost-sharing for individuals who do not fall under the new buy-in category.

Action History

1. February 14, 2019

   Introduced in Senate

2. February 14, 2019

   Read twice and referred to the Committee on Finance.

Sponsors

• Brian Schatz · Primary

Subjects