The State Public Option Act aims to expand access to affordable health insurance by creating a state-level Medicaid buy-in option. Beginning January 1, 2026, states may allow residents not currently enrolled in other health insurance to purchase Medicaid coverage. These individuals would be subject to premiums and cost-sharing, but states would receive 90 percent federal financial participation for administrative expenses of the buy-in program. Individuals participating in the Medicaid buy-in program would be eligible for Affordable Care Act (ACA) premium tax credits and cost-sharing reductions, with premiums capped at 8.5 percent of household income . States are required to offer enrollment in these buy-in plans through their ACA Exchanges. The bill also establishes a program for advance determinations and payments of these subsidies directly to state agencies. A significant provision of the bill mandates that states include comprehensive sexual and reproductive health care services , including abortion services, as a required medical assistance benefit under Medicaid, effective January 1, 2026. This coverage becomes a condition for state plan approval. Additionally, the bill renews and expands the enhanced Medicare payment rate floor for primary care services under Medicaid, extending it to a broader range of providers including Board-certified OB/GYNs and advanced practice clinicians. Furthermore, the legislation revises the enhanced Federal Medical Assistance Percentage (FMAP) for newly eligible individuals under Medicaid expansion. It ensures that states receive the most favorable federal matching funds (starting at 100 percent) for the first consecutive 12-month periods they provide medical assistance to newly eligible individuals, regardless of when they expand. The bill also appropriates $50 million for fiscal year 2026 to review and update Medicaid quality measures for the buy-in population.