State Public Option Act

Sponsor: Kim Schrier (Democratic-WA)June 12, 2025

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Introduced

In Committee

Passed One Chamber

Passed Both Chambers

Signed into Law

Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Lets states offer a Medicaid health insurance choice, boosts pay for primary care doctors, and requires reproductive health coverage.

This bill would let states offer a new Medicaid health insurance plan that anyone not currently insured could buy into, starting January 1, 2026. It would also increase how much Medicaid pays primary care doctors and other providers, and require states to cover comprehensive sexual and reproductive health services, including abortion, for all Medicaid beneficiaries.

What Would Change

Today, Medicaid is generally limited to specific low-income groups, and there's no national option for other residents to buy into it. Federal payments for primary care at Medicare rates were temporary and expired, and states have varying rules on covering comprehensive sexual and reproductive health care, including abortion. If this bill becomes law, states could offer a Medicaid buy-in option for all uninsured residents starting January 1, 2026, with federal financial support and Affordable Care Act subsidies. It would also renew and expand higher Medicaid payment rates for primary care providers and mandate Medicaid coverage for comprehensive sexual and reproductive health care services, including abortion, effective January 1, 2026.

Key Provisions

Lets states offer a new Medicaid health insurance plan that residents without other coverage could buy into, starting January 1, 2026.
Caps annual premiums for families in the Medicaid buy-in program at 8.5% of their household income.
Allows individuals buying into Medicaid to get federal premium tax credits and cost-sharing help, like those on the Affordable Care Act marketplace.
Boosts Medicaid payment rates for primary care services to at least 100% of Medicare rates for a wider range of providers, including doctors, nurse practitioners, and clinics.
Requires all state Medicaid plans to cover comprehensive sexual and reproductive health care services, including abortion, starting January 1, 2026.

View on Congress.gov

HR 3995 · 119th Congress · June 12, 2025 · AI Summary by gemini-2.5-flash · 1/10

State Public Option Act

What Would Change

Key Provisions

Lobbying Activity