Albany, NY — A new policy brief from the Rockefeller Institute of Government compares and contrasts three major approaches to Medicaid buy-in programs and outlines six fundamental questions for policymakers. 

The report, Medicaid Buy-In: Questions of Purpose and Design, comes amid growing discussion in health policy circles, especially at the state level, about the merits and mechanics of programs that allow generally ineligible populations to buy into Medicaid or Medicaid-based systems.
 
“With federal healthcare policy in flux, state-level programs like Medicaid buy-in are becoming increasingly important to both policymakers and the public,” said Rockefeller Institute President Jim Malatras. “By analyzing current proposals and identifying key considerations, the authors of this report provide a roadmap for states to expand access to quality, affordable healthcare.”
 
Medicaid is the nation’s largest health insurance program, covering one in five Americans. Its flexibility, coverage characteristics, and cost structure make it an attractive platform for advocates of expanding healthcare coverage, and the recent expansion in 32 states under the Affordable Care Act has shown it to be scalable.
 
In the past year, various Medicaid buy-in proposals have emerged in the states and in the Congress. The new Rockefeller Institute report describes, compares, and contrasts the three major types of these proposals: those that aim to increase eligibility; those that aim to increase stability; and those that aim to increase affordability.
 
The report also outlines six design issues that policymakers should consider in the development of a Medicaid buy-in or public option program. They include:

+ How large is the intended population of new enrollees?
+ What kind of coverage will be offered?
+ How will enrollment be financed?
+ How will rates be set?
+ Will the program use standard Medicaid rates, and will there be enough participating providers to meet enrollee demand?
+ How will the program fit into your state’s regulatory structure?

While federal healthcare policy has become a largely partisan issue, there is widespread support for increasing the affordability of healthcare — and Medicaid is increasingly being looked at as a flexible and scalable platform to achieve that. Policymakers weighing a buy-in program should carefully consider the issues outlined in this concise report.
 
The report is written by John Kaelin, visiting fellow at the Rockefeller Institute of Government and a senior advisor at Centene Corporation, and Katherine Hempstead, senior policy advisor at the Robert Wood Johnson Foundation.
 
Read the full report.