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Kaye, N., & Wysen, K. (2003). Using Medicaid to cover the uninsured: Medicaid participant Buy-In programs. Portland, ME: National Academy for State Health Policy.
Abstract
This report presents findings from a study on the potential for using Medicaid as a means to cover the uninsured through participant Buy-In programs. Using findings from a literature review, a survey of Medicaid Buy-In programs, and an expert meeting of state Medicaid officials, the study addresses features of state Buy-In program financing and barriers to the program's success.
In most states, participants must pay a premium or enrollment fee to participate in the Buy-In program. States most frequently use a sliding scale to charge premium levels, either as a minimum dollar amount, a percentage of income, or through more complex formulas. States varied widely in the amount of premiums collected per month, in mechanisms used to collect premiums. A majority considered their premium collection program successful, but many perceived problems in the design of their Medicaid programs and premium collection policies.
Suggested modifications to current Medicaid rules that could extend coverage to the uninsured include making eligibility rules more flexible and allowing Medicaid to pay the full cost of services. Medicaid officials also suggested more flexibility in federal rules for co-payment and benefits eligibility and addressed possible changes in their state policies for premium collection and other program operations.
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