S 4063 — State Public Option Act

Summary

State Public Option ActThis 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, 2025, 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 (i.e., federal matching rate) 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 sexual and reproductive health care services, including abortion services.

Bill Text

• Introduced Introduced in Senate Current html March 22, 2024

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

The bill establishes a Medicaid buy-in option for residents who are not concurrently enrolled in another health insurance plan, allowing them to access coverage subject to premium payments and cost-sharing requirements.

• 42 U.S.C. 1396a

  ''; → ''or''

  This change updates a condition to include new eligibility criteria for Medicaid coverage.

• 42 U.S.C. 1396a

  ; → ''XXIV) beginning January 1, 2025, 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 (uu) and notwithstanding section 1916 (except for subsection (k) of such section), to payment of premiums or other cost-sharing charges;''

  This adds a new eligibility category for individuals seeking Medicaid buy-in coverage starting January 1, 2025.

• 42 U.S.C. 1396a

  ''(uu) Previously Undescribed Individuals.--Individuals described in this subsection are individuals who are-- (1) described in subclause (XXIV) 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.''

  This defines a new category of individuals eligible for Medicaid under the buy-in program.

• 42 U.S.C. 1396b

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

  This modification extends federal financial participation to include new individuals participating in the Medicaid buy-in program.

• 42 U.S.C. 1396b

  ''(7) 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)(XXIV) (as found necessary by the Secretary for the proper and efficient administration of such a program); plus''

  This establishes enhanced financial support for states to cover administrative expenses associated with the new Medicaid buy-in program.

• 42 U.S.C. 1396o

  ``(k) Premiums and Cost-Sharing for Individuals Participating in Medicaid Buy-In Program.-- (1) In general.--Subject to paragraph (2), with respect to individuals who are eligible for medical assistance under subsection (a)(10)(A)(ii)(XXIV) of section 1902 and are described in subsection (uu) of such section, a State may-- (A) impose premiums, deductibles, cost-sharing, or other similar charges that are determined on an actuarially sound basis; and (B) vary the premium rate imposed on an individual based only on the factors described in section 2701(a)(1)(A) of the Public Health Service Act and subject to the same limitations on the weight which may be given to such factors under such section.''

  This introduces a framework for states to impose premiums and cost-sharing for individuals under the Medicaid buy-in program.

• 42 U.S.C. 1396o

  ``(2) Limitations.-- (A) Premiums.--The total amount of premiums imposed for a year under this subsection with respect to all individuals described in paragraph (1) in a family shall not exceed an amount equal to 8.5 percent of the family's household income (as defined in section 36B(d)(2) of the Internal Revenue Code of 1986) for the year involved.''

  This caps the total premiums for families participating in the Medicaid buy-in program to 8.5% of household income.

Action History

1. March 22, 2024

   Introduced in Senate

2. March 22, 2024

   Read twice and referred to the Committee on Finance. (Sponsor introductory remarks on measure: CR S2599-2600)

Sponsors

• Brian Schatz · Primary

Subjects