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Columbia University Mailman School of Public Health

Public Health Insurance for Parents

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Public health insurance for parents provides free or low-cost health insurance to those who lack private-sector coverage. There is significant variation in the types of plans that are available and in the eligibility criteria that parents must meet in each state. Most family plans are funded through Medicaid, but a handful of states have waivers to use the State Children’s Health Insurance Program (SCHIP) to cover parents or have state-funded programs.

Most states have chosen to expand coverage for custodial parents—in some cases significantly—beyond the minimum federal requirements. Children are more likely to be enrolled in health insurance programs and access services when their parents are also eligible for coverage. In addition, families whose income has recently increased beyond Medicaid eligibility limits are eligible for temporary coverage through transitional medical assistance.

Still, income limits for parents remain well below limits for children in most states—and state expansions typically apply only to custodial parents, not to noncustodial parents or childless adults. As of 2009, 45 states (including the District of Columbia) offered coverage to children in families with incomes up to 200 percent of the federal poverty level (FPL), but only 15 states (including the District of Columbia) offered coverage to parents at this earnings level. Moreover, while 24 states had raised earnings limits for parents up to or above the poverty level ($18,310 per year for a family of three in 2009), in 9 other states, limits remained below 50 percent of poverty. Even though most of these parents are employed, they often work in low-wage jobs that do not offer access to employer-based coverage. Nationally, approximately 20 percent of adults are uninsured, compared to about 11 percent of children.

Medicaid is a federal entitlement program that was enacted in 1965 to provide health insurance coverage for certain needy populations, including families receiving cash assistance, low-income children, the elderly, and the disabled. In the late 1980s and early to mid-1990s, Medicaid was gradually “de-linked” from cash assistance, beginning with coverage for pregnant women and young children. In 1996, Medicaid was fully separated from cash assistance, but with the requirement that states create a “Family Coverage Category” that offers coverage to families who meet the state’s 1996 cash assistance eligibility criteria. The following year, the SCHIP block grant was created to expand health insurance coverage for children. To receive federal Medicaid and SCHIP funds, states are required to spend matching funds, though the federal government pays a larger share of the cost of care provided through SCHIP.

Many states that have expanded coverage for parents have done this by raising income eligibility limits under the Family Coverage Category—also referred to as “Section 1931” for the section of the 1996 Social Security Act that created this category. Others have used Section 1115 waivers (under Medicaid or SCHIP) to create family coverage plans with limits well above the federal minimums.

National Participant & Spending Data

Data Notes and Sources

Data on Public Health Insurance for Parents were compiled by NCCP in April 2009. Some state policy decisions may have changed since these data were collected.