Almost half of states have program in place

A just-published report on state efforts to cover low-income adults without children found something encouraging. Researchers looked at all 50 states to see whether policies were in place to subsidize coverage for childless adults. They found that almost half of states had some type of program in place.

This is true despite the fact that Medicaid policy at the federal level makes it difficult for states to subsidize coverage for this population. Since childless adults aren't part of the mandatory groups in Medicaid for states to cover, they have to apply for waivers.

"These programs are not all funded by federal Medicaid dollars. Some are state-only funded," notes Sonya Schwartz, one of the study's authors and a program manager with the National Academy for State Health Policy in Washington, DC. "But lots of states are trying to do something about this. They think it's of value and they want to help. Many have done it, even though it's hard to do."

The programs don't necessarily offer comprehensive coverage like the traditional Medicaid program; not all are entitlement programs, the programs may have wait lists or caps, and some are just subsidies to help people buy employer-offered coverage.

"Some are narrowly drawn and tailored to low-wage workers or small employers. They are all different, and very few look like traditional Medicaid," says Ms. Schwartz. "But it is hopeful that states recognize the need, and they are trying to do something."

Previous research has looked at the different Medicaid waiver states that cover childless adults, but this study was the first to look at the eligibility roles, the benefits design, and the financing structure of all existing state programs.

"We tried to pull together everything, including the programs that subsidize coverage for workers of small employers which you wouldn't normally lump in with Medicaid, but which serve a lot of the same population—low-income workers," says Ms. Schwartz. "I was surprised at how high the number gets when you put all that together."

The report's findings "should be a lesson that states actually care about this," she points out. "It's not just Vermont and Massachusetts; it's all over the country. The programs in the middle of the country tend to be the waiver programs with more limited benefits. But this is not just a story about blue states on the coasts."

Federal policy "really does make a difference," says Ms. Schwartz, pointing to the State Childrens Health Insurance Program (SCHIP). "It is a small program, but in less than 10 years, the uninsured rate among children has dropped remarkably. It's partly because of higher eligibility level, but also because when you say all kids are welcome, it's like a welcome mat—you end up covering a lot of kids," she says. "Before we had SCHIP, we were in much worse shape. "