The "State Public Option Act" aims to establish a state public option through Medicaid, providing Americans with access to high-quality, low-cost health insurance. Beginning January 1, 2026, states may offer Medicaid coverage to residents who are not concurrently enrolled in other health insurance plans. Individuals participating in this buy-in program would be subject to premiums and cost-sharing, which states can determine on an actuarially sound basis, with premiums capped at 8.5% of household income. The federal government would provide an enhanced match of 90% for administrative expenses related to the Medicaid buy-in program. Participants would be eligible for premium tax credits and cost-sharing reductions , similar to those available under the Affordable Care Act, with their Medicaid buy-in coverage treated as a silver-level plan. States would be required to allow enrollment in this coverage through their established health insurance Exchanges. The bill renews and expands the application of Medicare payment rate floors for primary care services furnished under Medicaid. This expansion includes a broader range of providers such as OB/GYNs, advanced practice clinicians, and certain health centers, ensuring they receive equitable reimbursement. Additionally, the legislation extends the enhanced federal medical assistance percentage (FMAP) for newly eligible Medicaid individuals, applying it to the first seven consecutive 12-month periods a state provides such assistance, rather than specific calendar years. A significant provision mandates that Medicaid coverage must include comprehensive sexual and reproductive health care services , explicitly encompassing abortion services and abortion-related services . This inclusion is a condition for state plan approval and will take effect on January 1, 2026, ensuring access to a full range of reproductive health options for Medicaid beneficiaries. Finally, the bill directs the Secretary of Health and Human Services to review and update Medicaid quality measures by 2030. This ensures these measures are appropriate for the new Medicaid buy-in population, with corresponding state reporting requirements to be updated by 2032. To support these efforts, $50 million is appropriated for fiscal year 2026 for state implementation funding.