Public Health Insurance for Parents
Parents have access to public health insurance coverage primarily through plans that target “families”, with significant variation by state in the types of plans that are available and in the eligibility criteria that parents must meet. Most family plans are funded through Medicaid, but a handful of states have waivers to use State Children’s Health Insurance Program (SCHIP) funds to cover parents. In both cases, programs are funded through a combination of federal and state funds, with states establishing income eligibility limits and other key rules within federal parameters. [More detail and national data...]
Federal decisions are italicized.
Eligibility Criteria
Income eligibility criteria
Federal rules or guidelines1 | Medicaid rules require states to establish a "family coverage category" (commonly referred to as "section 1931") that offers coverage to parents who meet the AFDC income eligibility rules in effect in the state in July 1996. States may also expand eligibility through this category and/or others. (2001) |
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Applicant earnings limit for single parent with 2 children2 | $6,276/year (2009)3 |
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Parents eligible up to same limit as children, single parent with 2 children4 | No (2009) |
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Asset eligibility criteria
Federal rules or guidelines1 | Asset limits may not be less than $1,000. (2001) |
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Assets disregarded for eligibility determination5 | Yes (2009) |
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Two-parent families' eligibility
Two-parent families eligible on same basis as one-parent families6 | No (2002) |
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Immigrant eligibility criteria
Federal restrictions on lawful permanent residents' (LPRs) access to benefits7 | LPRs are generally barred during their first 5 years as LPRs; "deeming" may affect eligibility in other cases. (2006) |
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Legal immigrants eligible for state-funded benefits when barred from federal8 | Yes (2008) |
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Legal immigrants otherwise barred from benefits eligible for prenatal care9 | No (2008) |
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Participants
Number of recipients
Number of recipients (adults)10 | 300,005 adults (FY 2004) |
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Benefit coverage
Percent of adults without health insurance coverage11 | 12% (2007) |
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Spending
Total spending
Total spending (state and federal)12 | $865.8 million (FY 2004) |
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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.
- Kaiser Commission on Medicaid and the Uninsured, Low-Income Parents' Access to Medicaid Five Years After Welfare Reform, 2002.
- Figure reflects limit under Medicaid plan with highest income eligibility limit for parents, taking into account the value of earnings disregards (which may be time-limited in some cases).
Donna Cohen Ross and Caryn Marks. 2009. Challenges of Providing Health Coverage of Children and Parents in a Recession: A 50-State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and SCHIP in 2009, Kaiser Commission on Medicaid and the Uninsured. http://www.kff.org (accessed February 16, 2009).
- Pennsylvania also has a state-funded program with an eligibility limit of $36,636 per year, but parents may only enroll during open enrollment periods. Pennsylvania was not enrolling eligible parents at any time between July 2007 and January 2009.
- Value reflects comparison of applicant earnings limit for a single parent with 2 children to the highest Medicaid or SCHIP program eligibility limit for children ages 6-19.
Donna Cohen Ross and Caryn Marks. 2009. Challenges of Providing Health Coverage of Children and Parents in a Recession: A 50-State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and SCHIP in 2009, Kaiser Commission on Medicaid and the Uninsured. http://www.kff.org (accessed February 16, 2009).
- Donna Cohen Ross and Caryn Marks. 2009. Challenges of Providing Health Coverage of Children and Parents in a Recession: A 50-State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and SCHIP in 2009, Kaiser Commission on Medicaid and the Uninsured. http://www.kff.org (accessed February 16, 2009).
- In states that do not offer equivalent eligibility rules, two-parent families face stricter requirements than single-parent families.
Karen Gardiner, Michael Fishman, Plamen Nikolov, Asaph Glosser, and Stephanie Laud, The Lewin Group, Inc., State Policies to Promote Marriage: Final Report, U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, http://aspe.hhs.gov (accessed August 8, 2004).
- Immigrants who entered the U.S. before 8/22/96 are exempt from the 5-year bar; refugees and U.S. veterans (and their families) are exempt regardless of when they entered the country. "Deeming" refers to adding the income and/or resources of the immigrant''s sponsor to that of the immigrant''s in determining eligibility. See data source for more details.
National Immigration Law Center, Guide to Immigrant Eligibility for Federal Programs, Fourth Edition, 2002; with updates from Update Page, www.nilc.org/pubs/Guide_update.htm (accessed May 9, 2006).
- Lawful permanent residents (LPRs) are generally barred from federal benefits during their first 5 years as LPRs, unless they entered the U.S. before 8/22/96. Exceptions include refugees and U.S. veterans (and their families). See data source for more details.
National Immigration Law Center, Guide to Immigrant Eligibility for Federal Programs, Fourth Edition, 2002; with updates from Update Page, www.nilc.org/pubs/Guide_update.htm (accessed October 17, 2008).
- States have the option of using federal State Children's Health Insurance Program (SCHIP) funds to provide prenatal care to women regardless of immigration status. They can also extend prenatal care to immigrant women using state funds.
National Immigration Law Center, Guide to Immigrant Eligibility for Federal Programs, Fourth Edition, 2002; with updates from Update Page, www.nilc.org/pubs/Guide_update.htm (accessed October 17, 2008).
- Figure reflects "Medicaid Eligibles" (i.e., persons enrolled in Medicaid during the year, whether or not they received health care services), whose "Basis of Eligibility" is "Adult"; elderly and blind/disabled are not included. Most eligible adults are either pregnant women or parents (or other caretaker relatives) of Medicaid-eligible children, though a few states use waivers to extend coverage to childless adults. Data are based on states' eligibility and claims data submitted through the Medicaid Statistical Information System (MSIS) (for more information about Medicaid data sources, see http://www.cms.hhs.gov).
U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Medicaid Statistical Information System (MSIS) State Summary FY2004, http://www.cms.hhs.gov (accessed August 9, 2007).
- Figure reflects the percent of adults ages 18-64 who did not have health insurance coverage at any point during the year.
Current Population Survey, 2008 Annual Social and Economic Supplement, "Health Insurance Coverage Status and Type of Coverage by State and Age for All People" http://pubdb3.census.gov (accessed September 3, 2008).
- Figure reflects Medicaid payments for persons whose "Basis of Eligibility" is "Adult"; payments for elderly and blind/disabled are not included. Most eligible adults are either pregnant women or parents (or other caretaker relatives) of Medicaid-eligible children, though a few states use waivers to extend coverage to childless adults. Data are based on states' eligibility and claims data submitted through the Medicaid Statistical Information System (MSIS) (for more information about Medicaid data sources, see http://www.cms.hhs.gov).
U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Medicaid Statistical Information System (MSIS) State Summary FY2004, http://www.cms.hhs.gov (accessed August 9, 2007).