State Public Option Act
Sponsored By: Senator Brian Schatz
Introduced
Summary
Lets states offer a Medicaid buy-in for uninsured residents. It would also raise Medicaid primary care payment minimums, change how the federal match is timed for expansions, and require Medicaid to cover comprehensive sexual and reproductive health care including abortion.
Show full summary
- Individuals and families: People who are not already eligible for Medicaid and who lack other health coverage could buy into their state Medicaid plan starting January 1, 2026, if the state chooses to offer it.
- States: States that expand Medicaid for newly eligible people would receive the enhanced federal medical assistance percentage (FMAP) regardless of when they expand. The bill measures that match using each state’s first consecutive 12-month periods of providing coverage instead of fixed calendar years.
- Primary care providers: The bill would set a Medicaid primary care payment floor at no less than Medicare rates for many providers, including board-certified family physicians, internists, pediatricians, and board-certified obstetrician/gynecologists, plus rural health clinics and federally qualified health centers. It also extends the floor to advanced practice clinicians and requires minimum payment portions for nurse practitioners, physician assistants, and certified nurse-midwives so their pay meets required thresholds.
- People seeking reproductive care: State Medicaid plans would have to include comprehensive sexual and reproductive health services, including abortion and abortion-related services. Benchmark and benchmark-equivalent coverage could not enroll people unless those plans include these services, and these coverage requirements apply to care furnished on or after January 1, 2026.
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Bill Overview
Analyzed Economic Effects
5 provisions identified: 4 benefits, 0 costs, 1 mixed.
Premium tax credits for buy-ins
This bill would make people who buy into Medicaid and pay premiums eligible for ACA premium tax credits and cost‑sharing reductions if they meet the income rules. If no silver plan is offered where you live, your buy-in coverage would count as the second‑lowest‑cost silver plan for credit calculations. States could ask HHS and Treasury to make advance determinations and send advance payments of the credits and reductions to the State Medicaid agency, treated like an Exchange.
Higher Medicaid primary care pay
This bill would renew a rule that Medicaid must pay many primary care services at least 100% of the Medicare Part B rate. For services in 2013 and 2014 it would apply to family medicine, internal medicine, and pediatric physicians. After enactment the 100% floor would apply to a wider set of providers, including board‑certified family, internal medicine, pediatric physicians, some board‑certified OB/GYNs, qualified nurse practitioners, physician assistants, certified nurse‑midwives, rural health clinics, and FQHCs, under the bill's supervision and attestation rules. The bill would also ensure the portion of payment that goes to NPs, PAs, and CNMs meets minimum thresholds.
Medicaid coverage of reproductive care
This bill would add comprehensive sexual and reproductive health services, including abortion and related care, to Medicaid's definition of medical assistance. States would have to include these services in their State Medicaid plans. A State could not enroll people in benchmark or benchmark‑equivalent coverage that leaves out these services. These rules would apply to care furnished on or after January 1, 2026.
New timing for enhanced Medicaid match
This bill would change how the extra federal Medicaid match for newly eligible people is timed. Instead of fixed calendar years, the higher match would run in consecutive 12‑month periods starting when a State first provides medical assistance to newly eligible people. The change would take effect as if it had been included in the original ACA law.
New state Medicaid buy-in option
This bill would let a State offer a Medicaid buy-in that residents could buy through the State's ACA Exchange. You would be able to join if you live in the State and are not enrolled in another plan. States could charge premiums, but total premiums for all buy-in people in a family could not exceed 8.5% of the family's income per year. If a State collects more in premiums than it spends on these enrollees in a year, the State would pay 50% of the excess to HHS. The federal government would pay 90% of reasonable State administrative costs for running the buy-in when approved by HHS. The bill would also require HHS to review and update Medicaid quality measures for the buy-in population and it would appropriate $50 million for fiscal year 2026 to help with that work.
Sponsors & CoSponsors
Sponsor
Brian Schatz
HI • D
Cosponsors
Sen. Luján, Ben Ray [D-NM]
NM • D
Sponsored 6/12/2025
Jeff Merkley
OR • D
Sponsored 6/12/2025
Jeanne Shaheen
NH • D
Sponsored 6/12/2025
Richard Blumenthal
CT • D
Sponsored 6/12/2025
Sheldon Whitehouse
RI • D
Sponsored 6/12/2025
Amy Klobuchar
MN • D
Sponsored 6/12/2025
Peter Welch
VT • D
Sponsored 6/12/2025
Jacky Rosen
NV • D
Sponsored 6/12/2025
Tina Smith
MN • D
Sponsored 6/12/2025
Christopher Murphy
CT • D
Sponsored 6/12/2025
Cory Booker
NJ • D
Sponsored 6/12/2025
Richard Durbin
IL • D
Sponsored 6/12/2025
Martin Heinrich
NM • D
Sponsored 6/12/2025
Mazie Hirono
HI • D
Sponsored 6/23/2025
Roll Call Votes
No roll call votes available for this bill.
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