Expanding coverage

This State Health Policy Briefing explores recent decisions by the Centers for Medicare and Medicaid Services (CMS) which have serious implications for states striving to expand health coverage for children. Download available here.

This State Health Policy Monitor gives an overview of the key features of state laws designed to expand dependent coverage options for young adults. Policy makers are becoming aware that young adults are the fastest growing group of uninsured in America. In fact, they are more likely to be uninsured than any other age group. Nearly one-third (30 percent) of young adults ages 19-29 are uninsured. From 2004 to 2005, the number of uninsured adults ages 19-29 increased from 12.9 million to 13.3 million – an increase that accounted for 30 percent of the growth in the number of uninsured Americans under the age of 65 during this period.

This State Health Policy Monitor discusses the use of premium assistance, a program in which federal and state Medicaid and/or SCHIP funds help pay for employer-based or other private health insurance coverage, often using employer or enrollee fees to help pay premium costs. The program is used both as a strategy to cover individuals already eligible for Medicaid and to expand health coverage to the uninsured.   This Monitor briefly reviews federal rules for premium assistance programs under Section 1115 waivers and Section 1906 authority. It then examines key features of premium assistance programs under Section 1115 waiver authority.    

As states like Massachusetts, Vermont, and Maine continue to implement their health reforms, other states are also considering ambitious coverage expansions. Financing is a key concern. In the past, states interested in drawing down federal Medicaid funds to expand coverage had two primary mechanisms available to them: filing a state plan amendment using available optional eligibility categories and income disregards, or applying for a Section 1115 waiver. Under the first approach, states are required to provide all the Medicaid mandatory benefits, and to cover all people who meet the eligibility standards, with full federal financial participation guaranteed. The waiver approach gives states flexibility in areas like benefit design and eligibility, but limits the amount of federal financial participation because of budget neutrality requirements.