Premium Assistance

A number of states have premium assistance programs as part of Medicaid or SCHIP.  When cost-effective, the state pays the employee’s share of premiums for their employer-sponsored health plan, and also allows the person to continue to use Medicaid or SCHIP for any benefits that are covered by the public programs but not by their employer’s plan (known as “wrap-around”).  However, all but a few states have very small enrollment in their premium assistance programs.  

See Premium Assistance in Medicaid and SCHIP: Ace in the Hole or House of Cards?  by Cynthia Shirk and Jennifer Ryan for an outline of some conditions and strategies that can make premium assistance more successful.

For further information on building successful premium assistance programs, see:  

• Kaiser Commission on Medicaid and the Uninsured:  Joan Alker.  “Serving Low-Income Families Through Premium Assistance:  A Look at Recent State Activity"
• Joan Alker.  “Premium Assistance Programs:  Do They Work for Low-Income Families?”  Testimony Submitted to the House Education and Labor Committee, at http://edworkforce.house.gov/testimony/031507JoanAlkertestimony.pdf
• Institute for Health Policy Solutions, Ed Neuschler and Rick Curtis, Premium Assistance; What Works?  What Doesn’t?  at http://www.ihps.org/pubs/2003_Apr_PA_What_Works.shtml

Premium Assistance Decision Tree

1. Employer Size:  not greater than ___  (for instance, 50 employees)
2. Employer Income:  only offer to low wage employers?  (for example, an average wage base below the state median)
3. Should the employee (or their dependents) be otherwise eligible for Medicaid or SCHIP?  What is the eligibility level for the employee?  (for instance, 200% FPL)
4. Should the employer have to contribute a certain amount (or %) of premiums costs?  (Y/N)
   1. If Y, then minimum contribution ($ or %) is:
5. Should the employer benefit package meet a minimum standard?  (Y/N?)
   1. If Y, then define minimum benefit:
6. Should premium assistance be available to all employers, or only to those who did not previously offered insurance?
7. Should premium assistance be available to all employers, or only to firms with mostly low-wage workers (e.g. the median firm wage < state median wage)?