Premium Assistance Programs: Exploring Public-Private Partnerships as a Vehicle for Expanding Health Insurance to Rural Uninsured

Lead researcher:
Project funded:
September 2004
Project completed:
February 2006
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.


  • Premium Assistance Programs for Low Income Families: How Well Does It Work in Rural Areas?
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2006
    This paper reports the results of a study on the viability in rural areas of premium assistance programs use Medicaid or State Children's Health Insurance funding to subsidize the premium costs of employer-sponsored insurance or private non-group policies for eligible individuals.