Alternative Medicaid Expansion Models: Exploring State Options

This brief outlines key program design features of alternative Medicaid expansion models. It describes the premium assistance models Arkansas, Iowa, and Pennsylvania developed to use Medicaid funds to purchase private health insurance, as well as Michigan’s proposal to expand Medicaid using a health savings account model. Key themes emerging from these non-traditional proposals include: (1) a preference for solutions relying more on the private insurance market than on traditional Medicaid; and (2) an emphasis on higher enrollee cost-sharing, personal responsibility, and healthy behaviors.