State Efforts to Cover Low-Income Adults Without Children

Most Americans assume that our health insurance safety net covers the poor, regardless of family status.  In reality, a majority of uninsured Americans are low-income, childless adults who are not eligible for public health insurance programs. Out of the approximately 47 million people who are currently uninsured in the United States, 34 percent or 16 million people, are low-income childless adults.

This state health policy monitor describes programs in 23 states that provide health insurance coverage to low-income childless adults. While nearly half of states have programs in place to serve at least some of this population, many of these programs limit enrollment and provide limited benefits. The majority of these programs are financed in part with federal dollars through Medicaid §1115 waivers, and some are financed solely through state dollars. Some states have also created “premium assistance programs” where Medicaid or SCHIP funds help enrollees pay for employer-based or private health insurance.

This state health policy monitor examines states’ initiatives that provide free or reduced-cost health coverage for childless adults, including options for financing coverage, as well as key features of programs such as eligibility rules, benefit design, and cost sharing.