States that are pursuing Medicaid buy-in plans have considerable options in designing a plan to meet their goals. Buy-in plans will reflect key decisions on four major issues: 1) whether plans are sold on or off exchange, 2) whether plans are run by the state or a Medicaid Managed Care Organization, 3) who is eligible to purchase plans, and 4) which benefits and providers will be covered and at what payment rates. Our goal is to clarify the implications of these choices with respect to the goals and with respect to the tradeoffs each choice would involve.

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