Why Medicaid Buy-in?

With the Federal government in gridlock, states are taking the lead in finding innovative approaches and new coverage options to make health insurance more affordable and accessible.

Health care continues to cost Americans too much, and with a divided federal government, meaningful federal action to expand coverage or improve affordability is highly unlikely for the next two years. In the near-term, states will be the testing grounds for developing new ways to expand insurance coverage.

States control a broad portion of the health care marketplace, including running Medicaid, the program that provides health coverage to 1 in 5 Americans. States can use their experiences and existing infrastructure to add another, more affordable choice to the market. Medicaid buy-in is not a one size fits all policy; instead, states can use this idea to design an approach that will best address their state’s unique needs.

With states taking varying approaches to this new policy idea-- and lots of common questions about what Medicaid buy-in actually is-- this site aims to bring together the latest state by state progress on Medicaid buy-in along with additional resources and background information.

2018-2019 Medicaid Buy-in Activity


If you are aware of Medicaid buy-in state activity that is not mentioned here, let us know by contacting us.

State Spotlight

Colorado has enacted bipartisan legislation to develop a competitive state insurance option. The new law directs state agencies to develop a proposal for implementing a state option that leverages existing state health care infrastructure, increases competition, improves quality, and provides access to affordable health insurance.

State agencies are required to engage in a stakeholder process that includes public and private health insurance experts, consumers, advocates, employers, providers and carriers as they develop the proposal. After the agencies create the proposal and submit it to the legislature, state agencies must submit any necessary waivers or state plan amendments to the federal government needed for implementation. The waiver or amendment process may be paused if state legislation is filed in 2020 that substantially alters federal authorization necessary to implement the state option proposal.

Read more about Colorado’s new law here.

Washington has enacted legislation (SB 5526) that will create a new option known as CascadeCare. This law requires the Health Care Authority, with input from the state Exchange, to contract with one or more carriers to offer standardized QHPs on the bronze, silver, and gold levels. Beginning in 2021, all carriers offering plans inside the Exchange must also offer a silver and gold tiered standardized plan. Additionally, the bill directs the state to develop a plan for offering premium subsidies for those with incomes up to 500% of the federal poverty level.


The legislature voted to appropriate funds (through SB 536 and HB 548) to the Human Services Department to study and begin “administrative development” of a Medicaid Buy-in plan, including pursuing federal funding through a 1332 waiver. This study builds on the initial study done in early 2019 showing the merits of different Medicaid buy-in options for the state.