Medicaid Buy-In: Program Options and Considerations

State and federal policymakers have proposed various strategies to improve overall coverage and affordability, including allowing people to buy into their state Medicaid program or coverage comparable to that on the ACA exchanges. Although the details of various proposals differ substantially, they share a common element: using the flexibility allowed under the ACA to create new state-administered options as alternatives to existing exchange coverage. The term Medicaid buy-in is often used to describe such proposals because the programs would be administered by the state or rely on existing Medicaid infrastructure and would require individuals to pay a premium to purchase, or buy into, coverage