State Public Option Act
Sponsored By: Representative Schrier
Introduced
Summary
State Medicaid buy-in public option creates a new pathway for states to offer Medicaid-like coverage that residents can buy into, with capped premiums and coordination with premium tax credits.
Show full summary
- Families and individuals: Establishes a new beneficiary category for people who can buy into Medicaid. Premiums are limited to no more than 8.5 percent of family income, cost-sharing must follow ACA limits, and enrollees can qualify for premium tax credits under Internal Revenue Code section 36B.
- States and exchanges: States may offer the buy-in through their ACA Exchange and must treat buy-in enrollment as silver-level coverage for reporting and cost-sharing purposes. The bill authorizes 90 percent federal financial participation for administrative expenses and requires States to remit 50 percent of any premiums collected that exceed buy-in medical spending.
- Providers and quality: Raises a primary care payment floor to at least 100 percent of the applicable Medicare Part B rate for specified clinicians and facilities. Medicaid quality measures must be updated by January 1, 2030 with State reporting updates by January 1, 2032.
*Includes a $50.0 million appropriation for FY2026 to support implementation and authorizes enhanced federal participation for administration, increasing federal spending.*
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
5 provisions identified: 5 benefits, 0 costs, 0 mixed.
Buy-in costs capped, tax credits allowed
States could charge premiums and cost-sharing to the new buy-in group, but your family’s total premiums could not top 8.5% of income. Your copays and deductibles would have to follow ACA limits, and you could get cost-sharing reductions if your income meets ACA rules. Premium tax credits would count for buy-in premiums, and Treasury could pay them in advance to lower what you owe up front. For these rules, the buy-in would count like a silver plan; if no silver plan exists in your area, the buy-in would be treated as the second-lowest-cost silver plan. Some buy-in enrollees could not be charged under this rule, depending on their Medicaid category.
Medicaid must cover reproductive health
Medicaid would have to cover comprehensive sexual and reproductive health care, including abortion and related services. States using benchmark or benchmark-equivalent coverage could not leave these services out. This would apply to care provided on or after January 1, 2026.
New Medicaid buy-in option in states
States could offer a Medicaid buy-in starting January 1, 2026. You would need to live in the State and have no other health insurance. You could enroll through the State’s health insurance Exchange, and a State could limit sign-ups to open enrollment windows. Coverage would include the services listed for the buy-in in the bill.
Higher Medicaid pay for primary care
Medicaid payments for primary care would rise to at least Medicare Part B rates, or a higher 2009-based rate. After enactment, more providers, like OB/GYNs, nurse practitioners, and clinics, would get these minimums. Managed care plans would need to show they pay at least these amounts or use approved methods.
More federal support for state Medicaid
The federal government would cover 90% of states’ reasonable admin costs to run a Medicaid buy-in. HHS would update Medicaid quality measures by January 1, 2030, and states would update reporting by January 1, 2032. Congress would provide $50 million in 2026 to help states do this work. The bill would also change how enhanced federal match timing is counted, using consecutive 12‑month periods.
Sponsors & CoSponsors
Sponsor
Schrier
WA • D
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
View on Congress.govTake It Personal
Get Your Personalized Policy View
Start a Free Government Policy Watch to see how policy affects your household, then upgrade to PRIA Full Coverage for year-round monitoring.
Already have an account? Sign in