# 119-hr-3995: State Public Option Act

119-hr-3995, State Public Option Act, is a 119th Congress bill sponsored by Rep. Schrier, Kim [D-WA-8] (D-WA); status introduced; PRIA reads it as touching household money (as of 2026-04-21).

- Canonical: https://policyrisk.com/legislation/119-hr-3995
- As of: 2026-04-21
- Plain-text twin of the page above; the HTML and this file carry the same facts.

## Facts
- Bill: 119-hr-3995
- Congress: 119
- Title: State Public Option Act
- Status: introduced
- Introduced: 2025-06-12
- Sponsor: Rep. Schrier, Kim [D-WA-8] (D-WA)
- Cosponsors: 0
- Policy area: Health
- Touches household money: yes
- Last recorded action: 2026-04-21

## 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. - 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.*

## Provisions PRIA read

- Buy-in costs capped, tax credits allowed: benefit, high. 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 coun…
- Medicaid must cover reproductive health: benefit, high. 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: benefit, high. 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 lis…
- Higher Medicaid pay for primary care: benefit, medium. 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 appro…
- More federal support for state Medicaid: benefit, medium. 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 wo…

## Related bills

- 119-hr-4669: FEMA Act of 2025
- 119-hr-3077: Agriculture Resilience Act of 2025
- 119-hr-7977: Energy Bills Relief Act
- 119-hr-7481: Department of Homeland Security Appropriations Act, 2026
- 119-hr-7973: Momnibus Act
- 119-hr-9090: Advancing Menopause Care and Mid-Life Women’s Health Act

## Sources
- [119-hr-3995 on Congress.gov](https://www.congress.gov/bill/119th-congress/house-bill/3995)

## Related
- [119-hr-4669: FEMA Act of 2025](https://policyrisk.com/legislation/119-hr-4669)
- [119-hr-3077: Agriculture Resilience Act of 2025](https://policyrisk.com/legislation/119-hr-3077)
- [119-hr-7977: Energy Bills Relief Act](https://policyrisk.com/legislation/119-hr-7977)
- [119-hr-7481: Department of Homeland Security Appropriations Act, 2026](https://policyrisk.com/legislation/119-hr-7481)
- [119-hr-7973: Momnibus Act](https://policyrisk.com/legislation/119-hr-7973)
- [119-hr-9090: Advancing Menopause Care and Mid-Life Women’s Health Act](https://policyrisk.com/legislation/119-hr-9090)
- [All bills in Congress](https://policyrisk.com/legislation)

Source: PRIA, https://policyrisk.com/legislation/119-hr-3995 (as of 2026-04-21).