Sponsor
Kim Schrier
Representative · D-WA
Representative · D-WA
Allows State Medicaid buy‑ins from Jan 1, 2026; raises Medicaid primary care payment floor; requires coverage of comprehensive sexual and reproductive health (including abortion); funds metric updates.
Official title: To establish a State public option through Medicaid to provide Americans with the choice of a high-quality, low-cost health insurance plan.
Introduced June 12, 2025 by Kim Schrier · Last progress June 12, 2025
The bill expands and standardizes Medicaid coverage (including a buy‑in option, primary care payment parity, and mandated reproductive services) and provides federal funding to support states, while increasing program costs, implementation complexity, and legal/administrative risks for states, providers, and taxpayers.
Uninsured state residents can buy into Medicaid starting Jan 1, 2026, with eligibility for advance premium tax credits and cost‑sharing reductions and the option to enroll through ACA Exchanges, expanding affordable coverage and simplifying sign‑up.
Medicaid primary care providers (including nurse practitioners, physician assistants, and certified nurse‑midwives) — and rural health clinics/FQHCs — must be paid at least Medicare Part B rates for primary care, likely improving access to routine care and provider retention in underserved areas.
State Medicaid plans (including benchmark or benchmark‑equivalent plans) must cover comprehensive sexual and reproductive health services, including abortion, reducing coverage variability and improving access to reproductive care for low‑income people.
States can charge actuarially based premiums and cost‑sharing (capped at 8.5% of family income) for the buy‑in, which could make coverage unaffordable for some low‑income people the policy intends to help.
Raising provider payment floors, expanding coverage, and potential changes in FMAP timing could increase Medicaid spending for states and the federal government, raising long‑term costs for taxpayers and state budgets.
The bill creates substantial administrative and implementation complexity (new reporting, coordination with HHS/Treasury, FMAP recalculations, managed‑care documentation and provider attestations), increasing burdens on states, providers, employers, and CMS during rollout.
Based on analysis of 6 sections of legislative text.
Creates a state option to let residents buy into Medicaid starting Jan 1, 2026, while allowing states to charge actuarial premiums and cost‑sharing subject to ACA rating limits; strengthens Medicaid primary‑care payment rates and enforcement for managed care; updates timing for enhanced FMAP phases; requires Medicaid coverage of comprehensive sexual and reproductive health care (including abortion); and funds federal work to update Medicaid quality metrics ($50M for FY2026). Some technical payment and reporting rules are revised to align federal matching and state premium treatment.