Premium Assistance
Premium assistance programs offer another means by which states can increase the number of children and youth with special health care needs (CYSHCN) with insurance coverage. In premium assistance programs, a state agency pays all or part of a family’s health insurance premiums. These programs are often implemented for low-income working families who cannot afford the expense of family coverage under an employer-sponsored plan. Premium assistance programs have grown in popularity with the advent of CHIP, in part as a strategy to ensure that low-income families do not drop their employer-sponsored coverage in order to obtain less costly CHIP coverage for their children.
While the majority of premium assistance programs are administered by state Medicaid agencies (in at least 23 states by current count), some Title V programs also provide premium assistance for CYSHCN. In Alabama, for example, Title V may pay the private insurance premiums for families with incomes up to 200% of the FPL who have children enrolled in the Title V CYSHCN program, if it is cost-effective to do so.
In New Mexico, Title V purchases the premiums and covers the co-payments for Title V-eligible children who receive coverage under the Medical Insurance Pool, an insurance program funded by private insurance companies for individuals with selected high-risk diagnoses. Families of privately insured children pay a deductible of $500 or more to participate in this program. Similarly, Indiana operates the State Hemophilia Insurance Program that provides premium assistance for eligible families for the Comprehensive Health Insurance Program, that state’s insurance pool program.
Florida’s premium assistance program, Florida Healthy Kids, deserves special mention as a private/public partnership that has purchased insurance for over a million uninsured children since 1990, with more than 200,000 currently enrolled. The Florida Healthy Kids Corporation uses a combination of local, state, federal, and family funds to provide insurance coverage through commercial health plans for children who are ineligible for CHIP. The premiums are considered reasonable, and the program has attracted a large number of CYSHCN.
Medicaid-administered premium assistance programs vary widely in their design. In Virginia, the state provides a rebate of $100 per child for CHIP-eligible families under 200% of the FPL who purchase private insurance coverage. Maine provides premium assistance to low-income families and also has a program that permits families who lose Medicaid eligibility to buy Medicaid coverage for their children at $100 per child per month. The state of Washington has a very active outreach program to contact low-income workers, help them enroll in private coverage offered by their employers, and provide state support to pay the premiums.
For a more complete description of Medicaid and CHIP-administered premium assistance programs see the The University of Minnesota’s State Health Access Data Assistance Center (SHADAC) premium assistance web page at http://www.shadac.org/files/shadac/SHARE_PolicyTable_PremiumAssistance.pdf
