As states discuss ways to provide their citizens with affordable health care, one effort gaining traction would offer Medicaid plans on a state’s insurance marketplace, allowing those who previously did not qualify to gain access. These “Medicaid-for-all” plans, more commonly called “Medicaid buy-in” plans, would essentially allow individuals to buy into a state's Medicaid program.
Advocates for Medicaid buy-in programs see them as a way to reduce the number of uninsured people in a state, while opponents argue that these bills impose consequences on the current health insurance market. Opponents also point to flaws within the existing Medicaid system that may be exacerbated with an expanded user pool, and dispute research finding that Medicaid is cost-effective and increases access to care.
In 2018, lawmakers in 14 states have introduced legislation related to Medicaid buy-in, according to the Robert Wood Johnson Foundation's State Health and Value Strategies program. However, so far no state has enacted such a plan.
Among the bills introduced this session, legislation in Connecticut (CT HB 5463), Delaware (DE SR 70), and New Mexico (NM SM 3) would create task forces dedicated to studying the adoption of an expanded Medicaid buy-in program. Massachusetts (MA SB 638) and New Jersey (NJ SB 987) also have active legislation creating Medicaid buy-in programs for their citizens. Both states have the remainder of the year to act on the respective bills.
The most recent Medicaid buy-in program to gain serious traction was proposed in Nevada in 2017, making it to Governor Brian Sandoval’s (R) desk before he ultimately vetoed the bill. The Nevada program — nicknamed “SprinkleCare” in reference to its author, Assemblyman Michael Sprinkle (D) — would have allowed any uninsured resident to buy into the state’s Medicaid program.
The primary Medicaid story this year, however, has focused on several Republican-controlled states that have either considered Medicaid expansion legislatively or through ballot measures. As of July 2018, when Virginia enacted expansion, 33 states and the District of Columbia have chosen to expand their program for residents earning up to 138 percent of the federal poverty level (FPL). In Maine, despite voters adopting Medicaid expansion through a ballot measure last November, Governor Paul LePage (R) still refuses to file for federal support and has demanded that the legislature find a way to fund expansion. If Medicaid continues to grow in popularity as states expand the program to more eligible users, states could become more open to opening up Medicaid for anyone to buy into the program.