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More States Consider Medicaid Buy-In Option in 2019

Several states — including Colorado, Connecticut, Delaware, Minnesota, Nevada, New Mexico, Oregon, and Wisconsin — have expressed interest in allowing individuals who cannot afford private health insurance to buy into the Medicaid program if they are otherwise ineligible.

As part of any buy-in proposal, states would have to consider who would be eligible to buy Medicaid coverage and how much they would have to pay in out-of-pocket costs. It also would be important to consider financial incentives for providers and hospitals to participate in the program.

The idea of Medicaid buy-in has had the most momentum in New Mexico. To date, the state legislature has examined different policy options and continues to study the issue. The state is considering several buy-in options, including:

  • Medicaid buy-in for all, in which eligible individuals could apply their subsidies to out-of-pocket costs; and
  • Medicaid-like coverage for people ineligible for Medicaid and subsidized individual coverage.

New Mexico Governor-elect Michelle Lujan Grisham (D) supports creating a buy-in option. In her most recent role as a member of the U.S. Congress, she introduced Medicaid buy-in legislation at the federal level. The state likely will pursue legislation or federal waivers to create a Medicaid buy-in option in 2019.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Kelcie Jimenez is a former state policy analyst at America's Essential Hospitals.

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