California policymakers and other stakeholders are exploring state-based approaches to expand or improve coverage within the state. There are myriad ways California might seek to expand coverage as well as address consumer choice and health care affordability. Understanding the Rules: Federal Legal Considerations for State-Based Approaches to Expand Coverage in California identifies four approaches designed to expand coverage that have been discussed among California state policymakers. These include:

• Establishing a single-payer system
• Improving affordability of Covered California plans
• Expanding Medi-Cal to undocumented adults
• Creating a public coverage option on Covered California

These approaches interact, to varying degrees, with federal programs and federal laws. This paper explores those interactions to illuminate legal issues that the state and stakeholders would need to consider under each of the approaches.

The full report and executive summary, as well as links to other related materials, are available below.