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Access to Health Insurance

Overview

Health insurance is one way to protect a family’s assets. It mitigates the cost to a family for expenses resulting from a medical emergency or the treatment of a chronic illness – expenses that might otherwise require a family to spend long-term savings, sell assets or go into debt. Health insurance, including dental coverage, also encourages people to seek preventive care and treatment for injuries and illnesses, minimizing the impact a medical condition would otherwise have on an individual’s ability to earn income. However, rising health care costs and gaps in health insurance coverage mean that many individuals and families are one serious illness or accident away from financial instability and a loss of assets. States should increase access to health insurance by increasing income eligibility for public health insurance programs, such as Medicaid and other state-funded programs, as well as by streamlining the enrollment and renewal process. States should also ensure that basic preventive and restorative dental care are covered through Medicaid.

Policy Ratings

To see state-by-state policy data, click here.

Elements of a Strong Policy¹

CFED considers a state’s health insurance coverage policy strong if it meets the following criteria:

1. Are parents with incomes up to at least 200% of the FPL eligible for coverage under Medicaid or other state-funded programs? Approximately 63% of nonelderly uninsured parents have incomes below 200% FPL.² States should expand coverage to this population to reduce the number of uninsured. In addition, while most states have separate eligibility standards for children and for parents, it is well documented that increased coverage of parents leads to increased health care coverage among children.³ By creating a family eligibility standard, states simplify the process of enrollment for working parents and create a seamless public insurance system for the entire family.
2. Are childless adults with incomes up to at least 200% of the FPL eligible for Medicaid or other state funded programs? Although the majority of uninsured Americans are adults without children, Medicaid has not traditionally covered these individuals.⁴ Starting in 2014, PPACA requires states to expand Medicaid coverage to nonelderly individuals with incomes up to 133% of FPL, including childless adults. However, this expansion still excludes a vulnerable portion of low-income childless adults between 133% and 200% of FPL. States should extend coverage to childless adults up to the 200% threshold through state-funded programs or Medicaid waivers.
3. Has the state simplified procedures to maximize enrollment and retention in CHIP and Medicaid for children and parents? Simplified procedures increase enrollment and retention of eligible individuals in Medicaid and CHIP. Recognizing the value of simplification, the 2009 CHIP reauthorization offered states performance bonuses to implement procedures such as not requiring an in-person interview to enroll in the program and creating joint applications for CHIP and Medicaid. States should adopt simplification procedures for both CHIP⁵ and Medicaid for children and parents.⁶
4. Does the state’s Medicaid program cover basic dental care for adults? In addition to having an impact on overall health and the health of their children directly and indirectly,⁷ adult oral and dental health can be an integral factor in employability, job retention, and income/savings protection. Dental problems, such as tooth loss, can affect employability,⁸ while pain and infection can play a role in job retention and productivity.⁹ Delaying treatment due to lack of coverage often leads to more costly and complex treatments down the road.¹⁰ Ideally states should provide both preventive and restorative adult dental care for their residents; however, even coverage of basic dental services in the state’s Medicaid program that goes beyond emergency care for all adults is an important step for states to take.

Footnotes

1. CFED acknowledges the expert assistance of Judy Solomon of the Center on Budget and Policy Priorities, Enrique Marinez-Vidal and Isabel Friedenzohn of AcademyHealth and Meg Booth of the Children’s Dental Health Project.
2. Social and Economic Supplement, 2010” U.S. Census Bureau. Calculated by CFED using the CPS Table Creator, http://www.census.gov/hhes/www/cpstc/cps_table_creator.html.
3. “Five Good Reasons for States to Expand Family Coverage,” Families USA, April 2000, http://familiesusa2.org/assets/pdfs/5_good_reasonsf09b.pdf.
4. Some states have offered childless adults coverage via Medicaid waivers or state-funded programs.
5. Simplification procedures eligible for the CHIP performance bonus include (1) 12-month-continuous coverage, (2) no asset tests, (3) no face-to-face interview, (4) joint application for Medicaid and CHIP, (5) administrative renewals, which allows states to renew eligibility based on information available to them from other program records or databases, (6) presumptive eligibility, which allows certain health care providers to make preliminary eligibility decisions in order for individuals to receive care while they complete the application (7) express lane eligibility, which allows states to use eligibility for other public programs to determine that a child satisfies one or more components of eligibility for Medicaid or CHIP, and (8) premium assistance option. “Medicaid Performance Bonus “5 of 8” Requirements,” Kaiser Commission on Medicaid and the Uninsured and Georgetown University Health Policy Initiative Center for Children and Families, April 2009, http://ccf.georgetown.edu/index/cms-filesystem-action?file=ccf publications/federal schip policy/chip tip 5 of 8 final.pdf.
6. Simplified procedures for parents applying for Medicaid include (1) no face-to-face interviews, (2) no asset tests, (3) no paper documentation of income required at application or renewal, (4) online application process including online submission, electronic signatures, and no paper documentation requirements, (5) use of Social Security Administration data match to verify citizenship, (6) 12-month frequency of renewal, and (7) a simplified family application.
7. Dana Hughes and Joel Diringer, “Eliminating Medi-Cal Adult Dental: Costs and Consequences,” Dental Health Foundation and California Primary Care Association, June 2009, http://www.calohac.com/resources/documents/OHAC_Adultdentalcutbrief32009final.pdf.
8. Carol Pryor and Michael Monopoli, Eliminating Adult Dental Coverage in Medicaid: An Analysis of the Massachusetts Experience, (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, 2005).
9. Mary McGinn-Shapiro, Medicaid Coverage of Adult Dental Services, (Washington, DC: National Academy for State Health Policy, 2008), http://www.nashp.org/sites/default/files/Adult Dental Monitor.pdf.
10. Leonard Cohen, Richard Manski and Frank Hooper, “Does the Elimination of Medicaid Reimbursement Affect the Frequency of Emergency Department Dental Visits?” The Journal of the American Dental Association 127, (1996), p. 605-609.