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Premium Assistance Programs: Exploring Public-Private Partnerships as a Vehicle for Expanding Health Insurance to Rural Uninsured
Many states have created public-private partnerships to expand health insurance coverage to the uninsured. Among these, one group of programs, “premium assistance programs,” are designed to help lower-wage workers pay the premium costs of their employer-sponsored health insurance. States can finance premium assistance programs through state-only funds, or can seek to share the costs with the federal government through Medicaid and/or State Children’s Health Insurance Program (SCHIP) premium assistance programs. Recently, the Centers for Medicare and Medicaid Services (CMS) has given states more flexibility in designing premium assistance programs through Health Insurance Flexibility and Accountability (HIFA) 1115 waivers.
Currently, there are 16 states that have operational premium assistance programs. This project examines the experience of those states in implementing premium assistance programs in rural areas. The project assesses whether there are certain design features or certain types of rural communities where these programs may be more feasible, through a survey of state Medicaid and/or SCHIP agencies that have implemented or are considering implementing a premium assistance program
Study results are presented in a working paper.
Publications
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Premium Assistance Programs for Low Income Families: How Well Does it Work in Rural Areas?
Author(s): Pam Silberman, Laura Brogan, Charity Moore, Rebecca Slifkin
Report Number: Working Paper No. 85
Date: 01 / 2006
Reports results of a study on the viability in rural areas of premium assistance programs use Medicaid or State Children's Health Insurance (SCHIP) funding to subsidize the premium costs of employer-sponsored insurance or private non-group policies for eligible individuals. Because of the characteristics of rural residents and their employment markets, many stand to benefit from premium assistance programs, but there are also reasons to believe that these programs may be less successful in rural communities. Findings form the telephone survey of Medicaid or SCHIP officials in 14 of the 16 states with at least one premium assistance program indicate that premium assistance programs have not lived up to their potential. Enrollment in most of the states' programs has been small, and while positive in concept, these programs have inherent limitations that may preclude more widespread enrollment. Of particular concern is that rural residents are more likely to work for small employers who do not offer health insurance or have higher premiums or less comprehensive benefits. However, with creative program design, premium assistance programs may be a useful tool for states to expand health insurance coverage to the rural uninsured.
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