Bill > HR3995

This bill establishes a State Public Option through Medicaid, allowing Americans to buy into a low-cost health insurance plan beginning January 1, 2026. Individuals who are state residents and not enrolled in other health insurance can purchase Medicaid coverage, with premiums and cost-sharing determined on an actuarially sound basis. The total annual premiums for a family are capped at 8.5% of household income, and cost-sharing will follow rules similar to those for qualified health plans. Individuals will be eligible for premium tax credits and cost-sharing reductions, and the plan can be purchased through state health exchanges during standard enrollment periods. The bill also includes provisions to review and update Medicaid quality measures, renew and expand Medicare payment rates for primary care services, increase federal financial participation for newly eligible individuals, and require states to cover comprehensive sexual and reproductive health care services, including abortion services. Additionally, the bill provides enhanced administrative funding for states implementing the Medicaid buy-in program and ensures that managed care entities maintain appropriate payment rates for primary care providers.

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https://www.congress.gov/bill/119th-congress/house-bill/3995/all-info