State Specific Strategies

Alabama Child Caring - Blue Cross Blue Shield of Alabama operates the Alabama Child Caring program, which provides health insurance for uninsured children who are ineligible for public coverage. Eligibility is coordinated between this private program and Medicaid and SCHIP in a number of ways. The programs share a uniform application form and they coordinate applications between the public and private programs. Benefits are outpatient only. 

Chronic and Acute Medical Assistance program (CAMA) - CAMA is a state-funded program designed to help needy Alaskans with specific illnesses get the medical care they need to manage those illnesses. It is a program primarily for people age 21 through 64 who do not qualify for Medicaid benefits, have very little income, and have inadequate or no health insurance.

• Terminal illness
• Cancer requiring chemotherapy
• Chronic diabetes
• Chronic seizure disorder
• Chronic mental illness
• Chronic hypertension

Primary Care Program - The Arizona Department of Health Services operates a Primary Care Program (PCP) that provides access to primary care health services for uninsured, low-income Arizona residents of all ages.  The program serves Arizona residents with family income no greater than 200 percent FPL, who are uninsured and ineligible for AHCCCS, KidsCare, and/or Medicare. The purpose of the program is to develop and maintain an enhanced statewide capacity for delivery of comprehensive, community-based primary (health) care services to low-income, uninsured persons and other medically underserved Arizona residents. The program provides funding for qualified contractors to provide primary and preventive care services, preventive dental services, and limited behavioral health care. Contractors may charge persons a sliding scale fee service for recipients who earn between 100 and 200 percent FPL. 

Arizona Health Insurance Premium Tax Credit - The Arizona Health Insurance Premium Tax Credit was established in September, 2006. The state pledged up to $5 million in tax credits to subsidize private insurance premiums. Employers must have from 2-25 employees and have not offered coverage for 6 months. Eligible individuals must earn below 250 percent of FPL. The state pays 50 percent of the premium, up to $1,000 for individuals and $3,000 for a family.

Access for Infants and Mothers (AIM) program - This state-funded program was established in 1992. AIM offers low-cost health coverage for pregnant women and their newborns. It has been designed for middle-income families who don’t have health insurance and whose income is too high to qualify for no-cost Medi-Cal. AIM is also available to those who have health insurance if their deductible or co-payment for maternity services is more than $500. This program provides coverage for those between 200 and 300 percent FPL. In 2004, the state began enrolling infants born of AIM enrollees into the Healthy Families Program, California’s SCHIP program. California now draws Title XXI (SCHIP) funds to cover pregnant women between 200 and 300 percent FPL. 

In 2007, legislation was passed which required that “claim experience” and “health status” be deleted from the list of demographic “case characteristics” which health insurance carriers are allowed to use in setting premium rates for small employer health care plans. Also enacted in 2007 was a law that required group insurance policies to include coverage for mental disorders and defines “mental disorder” as posttraumatic stress disorder, drug and alcohol disorders, eating disorders, anxiety disorders and depressive disorders to the extent those disorders are not already covered as a biologically-based mental illness.

State-Administered General Assistance (SAGA) –SAGA provides medical assistance for adults who do not qualify for Medicaid (HUSKY) or who are awaiting eligibility determination. Unlike Medicaid, there are no categorical program requirements; eligibility is based on income and assets only.  Approximately 31,800 individuals were receiving medical assistance via the SAGA program as of June 2006.

The Delaware Community Healthcare Access Program (CHAP) - CHAP facilitates access to health care services for low-income uninsured individuals. CHAP screens individuals for Medicaid eligibility and, for those ineligible but with family income below 200 percent FPL, CHAP provides a volunteer or discounted primary care medical home, a statewide network of volunteer or discounted specialty services, discounted fee schedule labs and xrays, prescription assistance, and misc. other discounted allied health services. CHAP began in 2001 and as of January, 2008, nearly 15,000 people have been served by the program.  

Delaware Cancer Treatment Program - In May 2004, Delaware created and funded a program to pay for treatment for the uninsured diagnosed with cancer. The state-funded program, administered by the Delaware Division of Social Services, provides treatment for uninsured individuals up to 650 percent FPL who meet certain eligibility criteria.

DC Healthcare Alliance – The Alliance provides health care to uninsured District residents, regardless of citizenship status, who are ineligible for Medicaid with family incomes below 200 percent of the FPL delivered via Medicaid managed care organizations. The Alliance provides HMO-like coverage through a network of primary care “medical homes,” with specialty and hospital services from participating providers. This program is funded solely by the District. As of December, 2008, Alliance enrollment was approximately 49,500 individuals.

In May, Governor Charlie Crist signed into law a bill (S.B. 2534) that creates a new health insurance option, the Cover Florida program, for Florida’s uninsured residents starting January 2009. The bill outlines a plan that allows private insurers to competitively negotiate with the state to provide benefit plans which should cost approximately $150 or less per month.^[1]. Cover Florida sponsors must offer at least two plans: one with lower-level coverage, and one with catastrophic coverage. Nine carriers submitted proposals and six of those were selected by the state to participate in Cover Florida.^[2] The benefit designs must focus on primary and preventive care in order to discourage people from using emergency rooms as their source of primary care. At minimum, all benefits plans must include:

• Coverage for preventive services
• Screenings
• Office visits
• Urgent care
• Prescription drugs
• Durable medical equipment
• Diabetic supplies
• Hospital care

The legislation also creates the Florida Health Choices Corporation, described as a clearinghouse designed to promote health insurance choices for small business and help them fill out the necessary forms and paperwork.  Through the Corporation, small employers with 50 or fewer employees will be able to access coverage for their employees. Employees will have the ability to choose from a variety of health plans and services, including prepaid services, flexible savings accounts, and traditional insurance products. Employers will be required to establish Section 125 plans. The program will be administered by a 15-member board made up of appointees chosen by the Governor, the Senate president and the House speaker.^[3]

Hawaii's Prepaid Health Care Act (PHCA) - Hawaii's Prepaid Health Care Act of 1974requires nearly all employers to provide health insurance to their employees who worked 20 hours or more a week for four consecutive weeks. Employees must maintain the minimum of at least 20 hours a week to remain eligible.   Hawaii was the first state to implement an employer mandate and has one of highest rates of individuals covered under employer-sponsored insurance.   Starting in 2004, the Hawaii Department of Labor and Industrial Relations has conducted random audits of employers to assure compliance with PHCA.

Three-Share – Illinois has several “three-share” models, designed by local community groups, that combine contributions from the employer, the employee, and some community subsidy to create a lower-cost product traditionally aimed at small business.  Illinois had an active program in Winnebago (Rockford) County.  The program suspended operation in October 2006 until a more stable community subsidy could be developed.  Other programs in Macoupin and Sangamon counties will be able to begin enrollment once a stable community subsidy is in place.

Indiana passed legislation in May 2007 that, in addition to the programs listed above, accomplished the following things: 

• A tax credit to employers that establish a Section 125 plan. For employers who do not offer a fully insured health plan that satisfies Section 125 of the Internal Revenue Service code, the state will provide the lesser of $50 per employee or $2,500 for two years if the employer establishes a Section 125 plan.
• Offer small employers (2-100 employees) a tax credit up to 50 percent of the cost of a qualified wellness program.
• Allows certain small employers to join together to purchase health insurance.
• Expands the definition of 'dependent,' allowing parents to cover their children up until the age of 24 upon policyholder request.

In April 2007, the Kansas Legislature passed Senate Bill 11. Section four of the bill would create a phased-in premium assistance program that would provide premium subsidies for Kansans who earn less than 100 percent FPL to purchase private insurance actuarially equivalent to the state employee health plan. By 2009, Kansans who earn below 50 percent FPL would receive the assistance and each year afterwards the upper income limit would increase by 25 percent until the maximum of 100 percent FPL. The Kansas Health Policy Authority is authorized to seek federal financial participation.

In addition to the premium assistance program, Senate Bill 11 authorizes:

• Loan guarantees for eligible primary care safety net clinics
• The creation of the Small Employer Cafeteria Plan Development program to encourage small employers to take advantage of the federal pre-tax premium rules.
• The authorization of grants or loans for the purpose of forming associations to increase access to health care.

In 2006, the Kentucky legislature passed the Insurance Coverage, Affordability and Relief to Employers (ICARE) Act. ICARE will provide a subsidy to employees of small firms (2-25 employees) of $40 to $60 per employee per month. The subsidy is reduced by increments of between $10 and $15 each year. The program is available to small firms whose employers pay at least 50 percent of total premium, who are uninsured for 12 months or have one employee with a high-cost medical condition, and whose average employee wage is less than 300 percent FPL. All carriers who currently write in the Kentucky small group market are required to offer three ICARE benefit packages including: basic, enriched, and high deductible coupled with an account. The ICARE program is authorized for four years. The program began in November of 2006.

Dirigo Health Reform Act – This comprehensive state-wide health system reform, enacted in 2003, addresses costs, quality, and access to health care with the goal of establishing universal coverage within six years.  The Act includes a number of cost-containment initiatives, including system-wide health planning, public price disclosure, simplification of administrative functions and reductions in paperwork, and voluntary limits on hospital costs and new rate regulation on insurance premiums.  

The Act creates the Maine Quality Forum, which promotes quality of care initiatives and educates providers and consumers about medical practices and other quality of care indicators. The Act created DirigoChoice,which isan affordable health insurance option for small businesses, the self-employed, and eligible individuals without access to employer-sponsored insurance that offers discounts on monthly payments and reductions in deductible and out-of-pocket costs on a sliding scale to enrollees with incomes below 300 percent FPL.  

On November 19, 2007, Governor Martin O’Malley (D) signed the Working Families and Small Business Health Coverage Act which provides for subsidies to small employers and employees of small employers if the employer:

•  has not offered a health benefit plan within the prior 12 months;
• has two to nine eligible employees;
• meets certain low-wage requirements to be established through regulation;
• establishes a Section 125 payroll deduction plan to allow for pre-tax premium contributions; and,
• agrees to offer a wellness benefit that is designed to prevent disease, reduce poor clinical outcomes, and promote health behaviors and lifestyle choices.

The yearly allocation from the state for this program is scheduled to be $30,000,000.

• Coordinating and facilitating collaboration on health care quality improvement and cost containment initiatives by the various stakeholders in the health care system;
• Making recommendations on health care quality and cost containment initiatives and priorities to policy makers, state and local governmental entities, professional boards, the Maryland Patient Safety Center, industry groups, consumers, and other stakeholders;
• Developing a chronic care management plan to improve the quality and cost-effectiveness of care for individuals with, or at risk for, chronic disease;
• Facilitating the integration of health information technology in health care systems; and
• Examining and making recommendations regarding other issues relating generally to the Council’s mission to improve health care quality and reduce costs.

Massachusetts Health Reform Legislation

In 2006, the Commonwealth of Massachusetts passed landmark legislation with the goal of covering 95 percent of its residents within three years. This health care reform law includes provisions to increase access to health insurance, contain health care costs, and improve quality. The Massachusetts’ reform package is built on six key elements:

An individual mandate that all who can afford insurance obtain it

• The overall uninsured rate dropped from 6.4 percent in 2006 to 5.6 percent in 2007. Massachusetts is now the state with the lowest rate in the nation.
• More than 40 percent of the newly insured gained private coverage without any government subsidies. Among the state’s insured population, 82 percent have private insurance, 14 percent are covered by Medicaid, and 3 percent are enrolled in Commonwealth Care subsidized plans.
• The percentage of employers providing health insurance rose to 73 percent in 2007 and increased to 79 percent in 2008. The national rate is about 60 percent.

Three-Share – Michigan communities pioneered the “three-share” programs which share the cost of a premium between the employee, the employer, and the community. This initiative provides low cost health insurance to small employers and their workers.  As of October 2006, several Michigan counties have such programs in operation including the best known three-share program called the Muskegon Community Health Project.

MinnesotaCare - In 1992, MinnesotaCare was established to provide health coverage to the growing number of uninsured via a risk-based managed care delivery system.  It is funded through a tax on health care providers and enrollee premiums.  Since 1995 a portion of MinnesotaCare has also been funded with federal Medicaid funds for some eligible individuals, and since 2001 with SCHIP funds, under the 1115 waivers described above.  There have been several expansions in eligibility over the years.   The program currently enrolls families with children up to 275 percent FPL under Medicaid and childless adults up to 200 percent of FPL without federal funding.

GAMC – GAMC is a state-funded (general fund) health care program for low-income adults, ages 21 through 64, who have no dependent children under age 18 and who do not qualify for federal health care programs.  There are two levels of covered services. Adults with income at or below 75 percent of the FPL and assets within $1,000 per household may qualify for the comprehensive benefit package that includes doctor visits, hospitalization, prescriptions, eye exams, eye glasses, dental care and more.  Adults with incomes above 75 but at or below 175 percent of the FPL and assets within $10,000 for a household of 1 or $20,000 for a married couple may qualify for GAMC-Hospital Only, which provides inpatient hospital coverage, including physician services during hospitalization.

Effective July 1, 2009 eligibility for this program will extend to 250 percent of FPL for childless adults.

Health Care Coverage for non-citizens – Minnesota has state-funded MA and MinnesotaCare “look-alike” programs for individuals and families who meet all eligibility requirements for MA or MinnesotaCare, but who are not qualified for federal health care programs solely due to their immigrations status.  The MA state-funded program is paid with general funds, and the MinnesotaCare state-funded program is paid out of the Health Care Access Fund.

In May 2008, New Hampshire Governor John Lynch signed legislation to enact HealthFirst, a program designed to make health coverage more affordable by emphasizing wellness, prevention and chronic disease management.  The state will convene an advisory group to work out the details of implementation, but the general requirements of the program includes the following:

• The price of the plan will be set at 10 percent of the median wage – currently $262 in New Hampshire – and will include limits on out-of-pocket spending.
• All carriers with 1,000 members in the small group market need to offer the product. At least one carrier needs to meet the target premium, or a hearing is held to determine the reasonability of the target with proposed benefits. Depending on the hearing, all carriers may be required to offer the product at the target premium.
• The Insurance Commissioner will need to certify that the HealthFirst wellness plans create incentives for consumers, health care providers, employers and/or health carriers to:
  • Promote wellness;
  • Promote primary care, preventive care, and a medical home model;
  • Manage and coordinate care for persons with chronic health conditions or acute illness;
  • Promote the use of cost effective care; and
  • Promote quality of care by the use of evidence-based, best practice standards and patient-centered care.

Family Care Coverage

New Jersey’s FamilyCare program originally enrolled childless adults up to 100 percent FPL with state-only funds. Enrollment was capped as of September 1, 2001. Currently only those with income at 23 percent FPL may be eligible for coverage.

NJ FamilyCare ADVANTAGE

NJ FamilyCare Advantage provides managed care coverage, through Horizon NJ Health, to uninsured children under the age of 19 in families with income greater than 350 percent of the FPL.  If a family chooses to enroll its children into NJ FamilyCare ADVANTAGE, then all children in the family who are eligible for the program must be enrolled.  The family cannot choose which children to enroll.  Families who voluntarily disenrolled from a health benefit program must be without insurance for at least six months.

Rates for NJ FamilyCare ADVANTAGE are:

• $137 for one child; 
• $274 for two children; and
• $411 for 3 or more children.

New Mexico has created a portal to facilitate insurance coverage called the Insure New Mexico! SolutionsCenter. This initiative features health insurance products custom-designed for each small employer, based on employee demographics and the needs of a specific employer group.  The custom product will incorporate coverage for each employee through publicly administered products including New Mexico State Coverage Insurance (NMSCI), New Mexico Medical Insurance Pool (the Pool), the New Mexico Health Insurance Alliance and the Small Employers Insurance Pool (SEIP).

Premium Assistance for Maternity (PAM) covers pregnancy-related services for women who are ineligible for Medicaid maternity services due to income. The enrollee pays a one-time enrollment fee per pregnancy depending on the trimester in which she enrolls. Enrollment cost during the first 20 weeks of pregnancy is $150. Enrollment cost during the second 20 weeks of pregnancy is $300. 

Under the Insure New Mexico initiative, the state expanded access to care through innovative premium assistance programs for children and pregnant women who are not eligible for Medicaid due to income.  This public/private program not only helps more uninsured children receive the healthcare coverage they need, it also helps assure that children receive healthier starts by encouraging pregnant women to begin receiving healthcare services early in pregnancy.

Premium Assistance for Kids (PAK) covers children ages 0 to 12, or up to 18 years old if part of a sibling group with a child under age 12, who are ineligible for the New Mexikids program due to income. The state assists with 50 percent of the costs of the premium. Premiums range from $70 to $180 per month. The PAK benefit package (an individual commercial benefit package)includes preventive, primary and specialty care, inpatient and outpatient hospitalization, pharmacy, lab, x-ray and physical, occupational and speech therapy.

In August 2007, the state approved the budget for an expansion of Child Health Plus (CHPlus) to children in families with incomes up to 400 percent of the federal poverty level (FPL) - the previous eligibility level was 250 percent FPL.  Federal matching funds for the CHPlus expansion was denied by CMS on the basis of the “August 17 directive,” which stated that the federal government would not provide matching funds for expanding coverage to children unless certain criteria were met.  New York was deemed out of compliance.  In April, 2008 the New York governor signed legislation to expand CHPlus up to 400 percent of FPL using state funds.  That expansion took effect September 1, 2008.  Children receive free coverage up to 160 percent of FPL, then there are monthly premiums assessed on a sliding scale basis up to 400 percent of FPL. Families with incomes higher than 400 percent can then buy into the program at full cost.

adultBasic Program – In June 2001, the Health Investment Insurance Act (Act 77 of 2001) was signed into law.  Act 77 was an initiative that invested the proceeds of the state’s tobacco settlement in the health of Pennsylvania consumers. The program created as a result of this legislation, adultBasic, is designed to provide health insurance for adults with incomes up to 200 percent of the FPL who do not have health care coverage.  It is administered by the Pennsylvania Insurance Department. adultBasic offers basic benefits including preventative care, physician services, diagnosis and treatment of illness or injury, in-patient hospitalization, outpatient hospital services, emergency accident, and medical care.

In early 2003, the tremendous response to the program quickly outstripped the allocated funding, and a waiting list was created.  In 2005, nearly 38,000 Pennsylvanians were enrolled in the adultBasic program with approximately 110,000 people on the waiting list.  To ensure that the program continues to offer adultBasic coverage to the maximum number of people, every month an assessment of the total adultBasic expenditures is performed in conjunction with the budget and a determination is made as to whether sufficient funding is available to add new enrollees.  Offers are made as funding is available and people are enrolled on a first-come, first-served basis.

In February 2005, Pennsylvania Governor Edward G. Rendell announced an agreement with Pennsylvania's four Blue Cross/Blue Shield plans for an ongoing annual commitment of funds for Annual Community Health Reinvestment (ACHR).  Overall, this represents a commitment of nearly $1 billion over the life of the agreement.  In its first year, more than $85 million of the nearly $150 million in committed ACHR was used to provide affordable basic health care coverage for thousands of low-income and uninsured Pennsylvanians.  The remainder was committed to other health care-related services in the community. 

The Blue Plans agreed that a certain percentage of their premiums, based on a formula, will go toward providing health care for low-income Pennsylvanians.  For the next six years, 60 percent of those funds will be dedicated to providing health insurance through state-approved programs for both low-income and uninsured persons through programs like adultBasic.

As of May 2008, adultBasic covered 54,893 people.

For more information on Pennsylvania’s adultBasic program, visit www.ins.state.pa.us (click on “adultBasic”) or read more about the Community Reinvestment Agreement.

The Wellness Health Benefit Plan (HEALTHpact)

In 2006, Governor Donald Carcieri signed into law a new health initiative focused on providing premium relief for small businesses. Under this law, the Health Insurance Commissioner was empowered to work with business, insurance, and other stakeholders to develop a new, affordable health plan, called The Wellness Health Benefit Plan. For this new product, the Commissioner was given additional regulatory authority for product and rate approval. The legislation set a target premium of 10 percent of wages, while at the same time requiring the benefit design to meet certain affordability principles.

Meeting this legislatively-defined price point meant creating a product that would be priced approximately 25 percent below typical market rates^[1]. As such, it was intended to slow the erosion in the small group offer rate by providing an alternative to high deductible health plans for low wage small businesses. The new product, called HEALTHpact, achieves this price point through a combination of innovative Wellness elements that create financial incentives for individual enrollees to make healthier choices^[2].

The carriers began offering the HEALTHpact plans beginning in October, 2007.  As of March, 2008 there were approximately 500 enrollees across 130 small employer groups.  Enrollment is capped at 5,000 lives per insurer. 
Other important early lessons learned from the HEALTHpact development process that states should consider are as follows:

• Benefit Design:  The market responds best to incremental changes -- so, states are cautioned to keep benefit designs similar to existing market options.  Additionally, the carriers are well suited to handle detailed plan design – it is important to allow them some flexibility to anticipate and respond to market needs. 
• Wellness Elements: Employers like having employees with some incentives for healthy behavior, and for those incentives to be at the individual (rather than group) level.  However, many people are skeptical of health risk assessments, and the implications for exclusions and pre-existing conditions.
• Marketing:  Successfully introducing a new product into the marketplace requires significant outreach and education.  State and carrier resources must be allocated for this effort.  States must also consider the distribution channel:  Will the product be more work for them? Should they be certified to sell it? Should they get additional compensation?  In addition, in Rhode Island, HEALTHpact needed to be marketed as dual option so that employers could “try it out” without committing all their employees to the new product.

Cover Tennessee- In March 2006, Tennessee Governor Phil Bredesen (D) proposed several coverage expansions to the legislature. On June 5, the Governor signed into law Senate Bill 3895 which contains several coverage components including: CoverKids (SCHIP, described above), CoverTN, AccessTN (high risk pool) and CoverRX.

In March 2008 Utah lawmakers passed legislation that slightly increases the state sales tax in order to offset a new five percent tax credit for health care costs paid by residents who do not have access to an employer-sponsored health plan.  Self-employed residents and others that purchase individual health plans are eligible for the state's health care tax credit.  The maximum amount for this nonrefundable credit is $300 for single taxpayers, $600 for married couples filing jointly, and $900 for taxpayers with dependants.

In May 2006, the Vermont Legislature and Governor Jim Douglas (R) reached agreement on two initiatives to reduce the number of uninsured: Catamount Health and Premium Assistance. Catamount Health is a commercial product is designed to be affordable and comprehensive for people who have been uninsured for 12 months. Premium Assistance will provide financial assistance for those under 300% FPL to purchase employer-sponsored insurance or Catamount Health.  These initiatives began in October 2007 with the goal of assuring insurance coverage for 96 percent of Vermont's uninsured (children and adults) over the next several years.

Catamount Health Product: This new individual market product is designed to be affordable and comprehensive for people who have been uninsured for 12 months (with some exceptions) and are not eligible for existing programs. Coverage is based on the typical non-group market product offered in the state, but with much less cost sharing by the individual or family. The Catamount Health law specifies the specific service and cost benefits that must be included—e.g., for individual coverage, the plan cannot have more than a $250 deductible, 20 percent coinsurance, $10 office visit co-pay, no prescription drug deductible, no out-of-pocket for preventive and chronic care, and an out-of-pocket maximum of $800 per year.

Catamount Health Plan subsidies are provided on a sliding scale for uninsured individuals and families with incomes up to 300 percent of the FPL. In addition, the state provides similar premium assistance to low-income individuals with access to employer-sponsored insurance who have previously not enrolled in their employer’s plan.

Beginning in July 2007, employers pay a $91.25 per FTE quarterly assessment (with increases allowed as Catamount Health premiums change) based on the following parameters: employers without a plan that pays some part of the cost of insurance of its workers must pay the health care assessment on all employees. Employers who have coverage must pay the assessment on: workers who are ineligible to participate in the plan; and workers who refuse the employer’s coverage and do not have coverage from some other source.  A new exemption was added during the 2007 legislative session that exempts from the assessment seasonal or part-time employees who have coverage from another source (unless it is Medicaid or VHAP), if the employer offers insurance to all full time employees. The assessment exempts eight FTEs in 2007 and 2008; six FTEs in 2009; and four FTEs thereafter.

Catamount is financed through a combination of individual premiums, an assessment on employers who do not offer health insurance, new tobacco taxes, and federal matching funds via the Global Commitment Waiver.

Finally, Catamount Health must align with the Vermont Blueprint for Health’s Chronic Care Initiative, a collaborative approach that seeks to improve the health of Vermonters living with chronic diseases and prevent the spread of chronic disease utilizing the Chronic Care Model as the framework for system changes.  The health care debate in Vermont acknowledged the fact that the majority of health care dollars are consumed by individuals with chronic diseases such as asthma and diabetes. The legislature and the Governor recognized the potential to control the growth of health care costs and improve the quality of care delivered in the state by making chronic care management a focus of reform efforts. Health information technology is also a major focus that is expected to help improve quality and control costs.

Indigent Health Care Trust Fund - The Virginia General Assembly created the Indigent Health Care Trust Fund in 1989 as a public-private partnership involving the state government and private acute care hospitals.  The purpose of the fund is to help offset some of the charity care provided by Virginia’s private acute care hospitals. Capped at an annual appropriation, the fund reimburses hospitals for the cost of charity care provided to any person whose annual family income is equal or less than 100 percent FPL.

State and Local Hospitalization Program (SLH) - SLH provides funding for hospital costs incurred by indigent persons.  It differs from the Trust Fund because while the Trust Fund reimburses hospitals based upon an overall amount of charity care provided by each hospital, the SLH program is “claims-based” – specific claims incurred by eligible indigent persons are approved for payment. Subject to the annual appropriation, SLH assistance is available for hospital care provided to persons who are not eligible for full coverage under Medicaid with incomes at or below 100 percent FPL.

The Washington Health Insurance Partnership

Coverage for Non-Citizen Children - In January 2006, the Washington State Children’s Health Program (CHP) was re-instated in Medicaid to provide health coverage for non-citizen children in families up to 100 percent of federal poverty. Funding has been provided to cover about 14,000 CHP enrollees. In addition, non-citizen children in families up to 200 percent of federal poverty may enroll in Basic Health. 

West Virginia Small Business Plan - The West Virginia Small Business Plan allows small businesses access to the buying power of the Public Employees Insurance Agency (PEIA). Through a private-public partnership between the West Virginia Public Employees Insurance Agency (PEIA) and insurance companies that choose to offer the plan, the West Virginia Small Business Plan allows participating carriers to access PEIA’s reimbursement rates, enabling the new small business coverage cost to be reduced significantly. PEIA is the largest self-insured plan in the state, providing insurance to public employees in state agencies, state universities, and colleges, as well as county boards of education.  The Small Business Plan has similar goals to group purchasing arrangements because it builds on the buying power of a large group.  Program enrollment began in January 2005 and, as of the Fall of 2006, more than 1,200 were enrolled, representing 300 businesses.   

To learn more about this initiative, read SCI's Profile in Coverage. 

General Assistance Medical Program (GAMP) – The GAMP is a community safety-net system for uninsured residents in MilwaukeeCounty.  To be eligible for coverage an individual must be uninsured and have a family income below 90 percent FPL, depending on family size ($902 for one person).  GAMP covers services such as primary care and clinic services, inpatient and outpatient hospital care. GAMP is funded by state and federal Medicaid revenues as well as MilwaukeeCounty tax levy.   At any given point in time, there are between 7,000 and 10,000 individuals enrolled in GAMP.  The state is planning to incorporate GAMP into BadgerCare Plus in January 2009.