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GAO-10-258R: 

United States Government Accountability Office: 
Washington, DC 20548: 

January 19, 2010: 

The Honorable Max Baucus: 
Chairman: 
The Honorable Charles E. Grassley:
Ranking Member: 
Committee on Finance: 
United States Senate: 

The Honorable Henry A. Waxman: 
Chairman: 
The Honorable Joe Barton: 
Ranking Member: 
Committee on Energy and Commerce: 
House of Representatives: 

Subject: Medicaid and CHIP: Enrollment, Benefits, Expenditures, and 
Other Characteristics of State Premium Assistance Programs: 

Fiscal pressures, rising health care costs, and increases in the 
number of uninsured may lead states to look toward public-private 
partnerships to help finance health insurance coverage. Through 
Medicaid and the State Children's Health Insurance Program (CHIP), 
states have had long-standing authority to operate premium assistance 
programs that subsidize the purchase of private health insurance. 
[Footnote 1] Enacted in February 2009, the Children's Health Insurance 
Program Reauthorization Act of 2009 (CHIPRA), which reauthorized CHIP 
and made changes to Medicaid, provided states with additional options 
for operating premium assistance programs. As of November 2009, states 
had not implemented premium assistance programs under the new 
authorities provided by CHIPRA, but, as allowed by CHIPRA, states were 
continuing to operate their programs under preexisting authorities. 

Through premium assistance programs, states use Medicaid funds, CHIP 
funds, or both to subsidize the cost of private health insurance--such 
as employer-sponsored insurance (ESI)--for eligible individuals. As 
such, premium assistance programs contrast with direct coverage, where 
states provide Medicaid or CHIP benefits to enrollees by paying 
doctors and other providers directly or contracting with managed care 
organizations. Previous reports on premium assistance programs have 
described the programs' potential benefits, as well as potential 
issues that have been raised about them.[Footnote 2] One potential 
benefit reported is that premium assistance programs could generate 
cost savings for Medicaid and CHIP by leveraging private financial 
resources for health insurance coverage--such as employer 
contributions--and decreasing enrollment in direct coverage. 
Additional potential benefits include helping families make the 
transition to private health insurance, expanding coverage to family 
members who are not themselves eligible for coverage under Medicaid or 
CHIP, and supporting the private insurance market. In contrast, a 
reported issue with premium assistance programs is that there may be 
disparities in the benefits and cost-sharing protections offered to 
enrollees in such programs compared with those in direct coverage. 
Reports also note that premium assistance programs may not be cost- 
effective--that is, premium assistance may be more expensive than 
providing direct coverage through states' Medicaid and CHIP programs. 
Finally, reports have raised the possibility that premium assistance 
programs may create incentives for families to reduce their 
contributions toward the cost for health insurance coverage, thus 
shifting the costs of coverage to public funds. 

CHIPRA required GAO to study cost and coverage issues related to state 
premium assistance programs receiving Medicaid and CHIP funds. 
[Footnote 3] In this report, we describe states' premium assistance 
programs, including the (1) funding source, operating authority, and 
type of private health insurance coverage subsidized; (2) policies 
regarding eligibility and enrollment; (3) benefits, premiums, and cost 
sharing; (4) expenditures and cost-effectiveness policies; and (5) 
challenges program officials reported in implementing and operating 
such programs, as well as the effect that CHIPRA may have on these 
challenges. 

To describe these programs, we administered a Web-based survey to 
officials from the states that had premium assistance programs funded 
by Medicaid, CHIP, or both. To identify which states had premium 
assistance programs funded by Medicaid or CHIP, we asked Medicaid and 
CHIP officials in each state and the District of Columbia if the state 
used Medicaid or CHIP funds to subsidize the purchase of private 
health insurance.[Footnote 4] We compared the information we received 
from state officials with information in published reports and with 
information received from the Centers for Medicare & Medicaid Services 
(CMS)--the agency within the Department of Health and Human Services 
(HHS) that oversees states' Medicaid and CHIP programs--about which 
states have authority to operate premium assistance programs. On this 
basis, we identified 47 premium assistance programs in 39 states. 
[Footnote 5] Officials in 8 of the 39 states reported having 2 premium 
assistance programs; states with more than one program may have 
separate programs for different populations or one program funded by 
Medicaid and another funded by CHIP. From August through October 2009, 
we administered a survey to officials representing the 47 premium 
assistance programs we identified.[Footnote 6] To ensure the clarity 
and precision of our survey questions, we pretested the survey with 
officials from 3 states and with a researcher who has extensively 
studied premium assistance programs. The survey requested information 
about several dimensions of a state's premium assistance program, 
including funding sources, operating authorities, type of private 
health insurance subsidized, eligibility, enrollment, covered 
benefits, premiums, cost sharing, expenditures, and cost- 
effectiveness. The survey also asked respondents about any challenges 
faced in implementing and operating their premium assistance programs, 
as well as for their views on the effect that CHIPRA may have on those 
challenges. Of the 47 Medicaid-or CHIP-funded premium assistance 
programs we identified, we received survey responses from officials 
representing 45 programs in 37 states, although not every official 
responded to every question.[Footnote 7] We relied on the data as 
reported by the state officials who were identified as the primary 
contact for the premium assistance program and did not independently 
verify these data or ask CMS to verify them. However, we reviewed all 
responses for reasonableness and internal consistency, and followed up 
with state officials for clarification where necessary. Based on these 
activities, we determined these data were sufficiently reliable for 
the purpose of our report. 

We conducted our work from June 2009 through January 2010 in 
accordance with all sections of GAO's Quality Assurance Framework that 
are relevant to our objectives. This framework requires that we plan 
and perform the engagement to obtain sufficient and appropriate 
evidence to meet our stated objectives and to discuss any limitations 
in our work. We believe that the information and data obtained, and 
the analysis conducted, provide a reasonable basis for any findings 
and conclusions in this product. 

Background: 

Before the enactment of CHIPRA, states had the authority to operate 
premium assistance programs under Medicaid and CHIP. CHIPRA provides 
states with additional options for operating premium assistance 
programs. 

Premium Assistance Authorities that Preceded CHIPRA: 

The Medicaid and CHIP statutes authorize states to obtain federal 
funding for the operation of state premium assistance programs. A key 
authority to operate a Medicaid-funded premium assistance program was 
provided through section 1906 of the Social Security Act (SSA), 
[Footnote 8] which authorizes states to use Medicaid funds to purchase 
group health plan coverage for eligible individuals.[Footnote 9] 
Programs operated under section 1906 of the SSA are commonly referred 
to as Health Insurance Premium Payment programs. The authority to 
operate CHIP-funded premium assistance programs was first provided in 
section 2105(c)(3) of the SSA, which permits states to provide 
coverage to CHIP-eligible children and their families by subsidizing 
premiums for group health plan and nongroup coverage.[Footnote 10] 
Table 1 compares requirements for premium assistance programs under 
these two authorities, both of which existed prior to the enactment of 
CHIPRA. 

Table 1: Requirements under Two Premium Assistance Operating 
Authorities that Existed Prior to CHIPRA: 

Category: Eligibility; 
Section 1906 of the SSA: Individuals eligible for Medicaid or for CHIP 
Medicaid expansion programs[A]; 
Section 2105(c)(3) of the SSA: Individuals eligible for separate child 
health programs.[A] 

Category: Type of coverage subsidized; 
Section 1906 of the SSA: Group health coverage, such as employer-
sponsored insurance; 
Section 2105(c)(3) of the SSA: Group health coverage, such as employer-
sponsored insurance, and nongroup coverage. 

Category: Enrollees' existing or prior insurance coverage; 
Section 1906 of the SSA: Enrollees' existing insurance coverage does 
not affect eligibility; 
Section 2105(c)(3) of the SSA: Enrollees must not have had group 
health coverage for at least 6 months prior to enrollment in the 
premium assistance program; 
reasonable exceptions are permitted.[B] 

Category: Mandatory enrollment; 
Section 1906 of the SSA: Can be mandatory at state option[C]; 
Section 2105(c)(3) of the SSA: Can be mandatory at state option.[D] 

Category: Benefits; 
Section 1906 of the SSA: States must ensure that enrollees have access 
to the full range of Medicaid benefits[E] either through the group 
health coverage or wraparound coverage[F]; 
Section 2105(c)(3) of the SSA: States must ensure that children 
receive benefits meeting requirements for CHIP benchmark coverage, 
benchmark-equivalent coverage,[G] or Secretary-approved coverage, 
either through the group health coverage or wraparound coverage.[F] 

Category: Premiums and cost sharing[H]; 
Section 1906 of the SSA: Same as for direct coverage in Medicaid.[I] 
Premiums are prohibited for individuals with incomes at or below 150 
percent of the federal poverty level (FPL) and for pregnant women and 
certain children at higher incomes. Cost sharing is prohibited for 
some services and groups[J] and is otherwise limited to nominal 
amounts for individuals with incomes below 100 percent of the FPL but 
is allowed to be as much as 20 percent of service costs for 
individuals with higher incomes. Total premiums and cost sharing for 
eligible individuals in the family cannot exceed 5 percent of family 
income; 
Section 2105(c)(3) of the SSA: Same as for direct coverage in CHIP.[I] 
Specific limits on premiums and cost sharing exist for families with 
incomes at or below 150 percent of the FPL. Cost sharing is prohibited 
for preventive care. Total premiums and cost sharing for eligible 
individuals in the family cannot exceed 5 percent of family income. 

Category: Cost-effectiveness; 
Section 1906 of the SSA: States may enroll eligible individuals as 
long as the cost, including premiums and cost sharing under the group 
health plan and any additional administrative costs, is likely to be 
less than the cost of an equivalent set of Medicaid services.[K] Cost-
effectiveness can be measured on an individual or aggregate basis; 
Section 2105(c)(3) of the SSA: States may enroll eligible individuals 
in health coverage as long as the cost is not greater than the cost of 
direct coverage.[I] Cost-effectiveness can be measured on an 
individual or aggregate basis. 

Category: Covering noneligibles; 
Section 1906 of the SSA: States may pay premiums to enroll noneligible 
family members in a group health plan if cost-effective and needed to 
obtain coverage for the Medicaid-eligible family members. Federal 
matching funds are not available to pay cost sharing for noneligibles; 
Section 2105(c)(3) of the SSA: States can purchase coverage for 
noneligible family members, provided the family includes at least one 
CHIP-eligible child. Coverage for the family must cost no more than 
direct coverage for the eligible children.[I] 

Category: Employer contribution; 
Section 1906 of the SSA: No minimum contribution specified; 
Section 2105(c)(3) of the SSA: States must identify a minimum 
contribution representative of the employer-sponsored market in their 
state and evaluate whether substitution of public for private coverage 
is occurring. 

Source: GAO analysis of Medicaid and CHIP statutes and regulations, 
and interviews with CMS officials. 

[A] Individuals eligible for Medicaid include certain mandatory 
populations, such as low-income pregnant women and children. Other 
populations, including those with higher incomes, can be covered at 
state option. CHIP was designed to provide health care coverage to 
children in families whose incomes, while low, are above Medicaid's 
eligibility requirements. States may use one of three basic options 
for structuring their CHIP programs: (1) a Medicaid expansion program, 
(2) a separate child health program, or (3) a combination program that 
includes both a Medicaid expansion and a separate child health 
program. States operating CHIP Medicaid expansion programs must follow 
Medicaid rules, while states operating separate child health programs 
follow CHIP rules. 

[B] See 42 C.F.R. §457.810 (2009). Requiring enrollees to be without 
coverage for at least 6 months is intended to discourage crowd-out--
the substitution of public health insurance for private insurance. 
Separate CHIP programs are required to monitor the extent to which 
crowd-out may be occurring among enrollees in direct coverage, and 
programs with eligibility thresholds above 200 percent of the FPL may 
be required to implement policies to minimize crowd-out. For more 
information on state efforts to monitor crowd-out, see GAO, State 
Children's Health Insurance Program: CMS Should Improve Efforts to 
Assess whether SCHIP Is Substituting for Private Insurance, GAO-09-252 
(Washington, D.C.: Feb. 20, 2009). 

[C] Eligible children cannot be denied direct coverage if their parent 
fails to enroll them in the group health plan. 

[D] States must offer individuals the option, at initial enrollment 
and at redetermination of eligibility, of enrolling in direct coverage 
if their group health plan does not provide certain enrollee 
protections specified in the CHIP regulations, including the 
opportunity for external review of delays or denials of health 
services. 

[E] Medicaid requires certain mandatory benefits, such as physician 
and hospital services, and states can also cover optional benefits 
such as dental services and prescription drugs. 

[F] Benefits wraparound coverage refers to states' direct coverage of 
any services to which premium assistance enrollees are entitled but 
which are not covered under their private health insurance plan. 

[G] A benchmark benefits package is a package substantially equivalent 
to the benefits provided by the Federal Employee Health Benefits 
Program's Blue Cross/Blue Shield Standard Option, a health benefits 
plan offered by the state to its own employees, or a plan offered by 
the HMO with the largest commercial enrollment in the state. A 
benchmark equivalent package has the same actuarial value as one of 
the benchmark plans. 

[H] Premiums are payments required for insurance coverage for a given 
period of time. Cost sharing is an out-of-pocket payment for part of 
the cost of services used by an enrollee and can include coinsurance, 
copayments, and deductibles. 

[I] Direct coverage refers to the coverage provided to Medicaid or 
CHIP enrollees who are not in premium assistance. For example, in 
Medicaid, direct coverage includes all mandatory benefits and any 
optional benefits that the state has chosen to provide. 

[J] Cost sharing is largely prohibited for children in mandatory 
coverage groups; for any preventive services for children, regardless 
of income; and for pregnancy-related services. 

[K] Cost-effectiveness is defined in section 1906(e)(2) of the SSA and 
further explained in Section 3910 of the State Medicaid Manual. 

[End of table] 

Under certain circumstances, a state may operate a premium assistance 
program that does not follow the Medicaid or CHIP statutory 
requirements that usually apply. To do so, states must obtain a waiver 
under section 1115 of the SSA. Section 1115 of the SSA allows the 
Secretary of HHS to waive certain statutory requirements in the case 
of experimental, pilot, or demonstration projects that are likely to 
promote program objectives.[Footnote 11] According to CMS officials, 
section 1115 waivers have been used to permit states to provide 
premium assistance to populations not otherwise eligible for coverage 
and to subsidize the cost of nongroup health coverage. Additionally, 
premium assistance programs operated under section 1115 waivers may 
not have to comply with all of the benefits, premiums, cost sharing, 
and cost-effectiveness requirements outlined in table 1 above. 

Additional Options for Premium Assistance Available under CHIPRA: 

When CHIPRA was enacted in February 2009, it created additional 
options for premium assistance in Medicaid and CHIP, including 
allowing states to subsidize ESI for Medicaid-and CHIP-eligible 
children and their parents if the employer's contribution is at least 
40 percent of the total premium cost, enrollment in the program is 
voluntary, and the ESI meets certain criteria.[Footnote 12] CHIPRA 
requires states that operate premium assistance programs under these 
new options to provide the full range of Medicaid or CHIP benefits 
through benefits wraparound coverage, where states directly cover any 
services to which premium assistance enrollees are entitled but which 
are not covered under their private health insurance. Additionally, 
CHIPRA specifies limits on the amount of enrollee cost sharing. 
Premium assistance programs that operate under the new Medicaid option 
created through CHIPRA do not have to meet a cost-effectiveness 
requirement. 

CHIPRA also amended the Employee Retirement Income Security Act 
(ERISA) of 1974, the Internal Revenue Code of 1986, and the Public 
Health Service Act to make eligibility for Medicaid or CHIP a basis 
for enrollment in a group health plan for which the Medicaid or CHIP 
enrollees are otherwise eligible to enroll. As a result of this 
change, new Medicaid or CHIP enrollees may not be required to wait for 
an open enrollment period to enroll in a group health plan and 
participate in the state's premium assistance program because Medicaid 
or CHIP eligibility would be considered a qualifying event. CHIPRA 
also requires health plan administrators to provide information about 
plan benefit packages when requested by states, and requires employers 
to provide written notice to employees about the availability of 
premium assistance if their state operates a program. 

Results In Brief: 

Funding Source, Operating Authority, and Type of Insurance Coverage 
Subsidized: 

* Based on our survey results from 45 of the 47 premium assistance 
programs, 30 premium assistance programs were funded solely by 
Medicaid, 6 programs were funded solely by CHIP, and 9 programs were 
funded by both Medicaid and CHIP. 

* According to our survey results, most premium assistance programs 
operated under the authority of section 1906 of the SSA (29), while 16 
programs operated under section 1115 waivers, 1 program operated under 
section 2105(c)(3) of the SSA, and 9 programs operated under other 
authorities. These other authorities include section 1902(a)(10)(F) of 
the SSA which allows states to use Medicaid funds to pay premiums for 
COBRA continuation coverage for certain low-income individuals and 
section 1905(a) of the SSA which allows states to use Medicaid funds 
to subsidize private health insurance premiums. In some cases, states' 
premium assistance programs operated under multiple authorities. 

* All but two premium assistance programs operated statewide. The two 
exceptions were Florida's program, which operated in five counties, 
and Colorado's CHP+ at Work program, which operated only in the 
metropolitan Denver area. 

* Based on our survey results, all 45 of the premium assistance 
programs subsidized premiums for some type of group coverage, with 32 
of the programs subsidizing premiums for multiple types of group 
coverage. More specifically, 43 programs subsidized coverage for ESI, 
32 subsidized COBRA coverage, and 17 subsidized other group health 
coverage. Of the 43 premium assistance programs that subsidized ESI, 

- 8 required that employers contribute a minimum amount toward the 
cost of enrollees' premiums, with the required minimum contribution 
ranging from 25 to 50 percent; 

- 5 limited participation to employers with a certain number of 
employees, typically fewer than 100; and: 

- 8 had data on the number of participating employers; among those 8 
programs, the number of participating employers ranged from less than 
30 to nearly 4,800. 

* Twenty-one of the 45 premium assistance programs subsidized nongroup 
coverage, namely policies purchased from the individual market. 

Enclosure I provides additional information on the funding source, 
operating authority, and type of insurance coverage subsidized for 
states' premium assistance programs. 

Eligibility and Enrollment Policies: 

* Twenty-five of the 37 premium assistance programs that provided 
eligibility information covered only low-income individuals--which the 
Census Bureau defines as those with family incomes at or below 200 
percent of the FPL. The remaining 12 programs covered at least some 
individuals with family incomes above 200 percent of the FPL, but only 
2 of the 12 covered any individuals with incomes above 300 percent of 
the FPL. 

* Most of the 37 programs that provided eligibility information 
covered children (32 programs), parents (29 programs), or pregnant 
women (27 programs).[Footnote 13] Fewer covered childless adults (13 
programs) or other groups (12 programs).[Footnote 14] 

* Thirty-three of the 45 premium assistance programs subsidized 
premiums for noneligible family members under certain circumstances-- 
for example, if the noneligible family member had to be enrolled in 
the health plan for the eligible family member to obtain coverage. 

* At least 8 programs targeted premium assistance to individuals with 
high health care costs, such as pregnant women, premature or low birth 
weight infants, or individuals with human immunodeficiency virus/ 
acquired immunodeficiency syndrome (HIV/AIDS), diabetes, or cancer. 

* According to our survey results, fewer than half of the premium 
assistance programs (20) mandated enrollment for any eligible 
individuals. Programs with mandatory enrollment required individuals 
to enroll in the premium assistance program if they had access to 
private health insurance and met the program's eligibility 
requirements; individuals who chose not to enroll in premium 
assistance would not be eligible for direct coverage from the state. 
[Footnote 15] Of the 20 programs with mandatory enrollment, 19 
required all eligible individuals to enroll, while the remaining 
program required only certain individuals to enroll. 

* Eleven programs, 10 of which were at least partially funded by CHIP, 
imposed waiting periods, requiring individuals to be without group 
health insurance for some period of time--typically either 3 or 6 
months--before they could enroll in the premium assistance program. 

* All 45 programs collected documentation of individuals' enrollment 
in private health insurance. Most also reported collecting a 
description of benefits offered by that insurance plan (38 programs), 
as well as documentation of premiums (35 programs). 

* Reported premium assistance program enrollment--generally as of June 
30, 2009--ranged from fewer than 10 individuals in 5 programs to more 
than 10,000 individuals in 4 programs--including 1 program with more 
than 30,600 individuals. Over half of the programs (25) had fewer than 
1,000 enrollees. 

Enclosure II provides additional information about eligibility and 
enrollment policies for states' premium assistance programs. 

Benefits, Premiums, and Cost Sharing: 

* Officials from almost three-quarters of the state premium assistance 
programs (33) reported that the program has minimum requirements that 
private health insurance benefit packages must meet in order to 
qualify for a state subsidy. The most commonly reported requirements 
were requiring coverage of certain services specified by the state (20 
programs)--such as inpatient and outpatient hospital and physician 
services--and meeting state health insurance regulations (16 
programs). Twelve programs did not have any requirements for the 
private health insurance benefit package. 

* Thirty-three premium assistance programs provided complete benefits 
wraparound coverage to some or all eligible individuals, meaning the 
state supplemented private insurance benefits up to the level 
individuals would receive under direct coverage.[Footnote 16] Of the 
remaining 12 programs, 3 programs provided partial benefits wraparound 
coverage to some or all eligible individuals[Footnote 17] and 9 
programs provided no benefits wraparound coverage.[Footnote 18] 

* Officials from 34 premium assistance programs reported that they did 
not monitor access to care or utilization of services for individuals 
enrolled in the premium assistance program. Of the remaining 11 
programs, 7 programs monitored utilization of services, 3 programs 
monitored both utilization of services and access to care, and 1 
program did not report whether it conducted either type of monitoring. 
Programs' monitoring efforts typically involved examining enrollees' 
private insurance claims, often in the process of determining whether 
their enrollment in premium assistance was cost-effective for the 
state. 

* According to our survey results, at least 26 programs paid 100 
percent of the enrollee's share of the premium. Officials from a few 
other programs indicated that the program may pay 100 percent of the 
enrollee's share of the premium under certain circumstances. Other 
programs varied in the extent to which they subsidized premiums. For 
example, some programs paid a specified dollar amount and some paid a 
percentage that was less than 100 percent of the enrollee's share of 
the premium. Officials from 2 programs did not provide information on 
the way in which the program subsidizes enrollees' premiums. 

* Officials from most programs (34) reported that the programs paid 
some or all cost sharing for at least some eligible individuals; cost 
sharing refers to out-of-pocket costs other than premiums, such as 
copayments.[Footnote 19] The remaining 11 programs did not pay cost 
sharing for any eligible individuals.[Footnote 20] 

* At least 5 programs limited the amount of out-of-pocket costs, such 
as premiums and cost sharing, which an individual enrolled in the 
premium assistance program would have to pay in a year. 

Enclosure III provides additional information about benefits, 
premiums, and cost sharing in states' premium assistance programs. 

Expenditures and Cost-Effectiveness Policies: 

* Among the 42 premium assistance programs that provided expenditure 
data, annual expenditures for premium assistance totaled at least $222 
million.[Footnote 21] Actual expenditures, however, were higher, 
because 32 of the 42 programs did not provide data for all program 
activities. For example, 19 of the 42 programs did not report the 
amount of expenditures for program administration.[Footnote 22] 
Furthermore, 3 premium assistance programs did not provide any data on 
program expenditures. 

* Thirty-eight programs required premium assistance to be cost- 
effective, meaning that the cost for Medicaid or CHIP to provide 
premium assistance is likely less than the cost to provide direct 
coverage. Of those 38 programs, 32 assessed cost-effectiveness on an 
individual or family level, while the remaining 6 assessed cost- 
effectiveness on an aggregate (or programwide) level. To calculate 
cost-effectiveness, 18 of the 38 programs reported using the method 
outlined in the State Medicaid Manual--referred to as the Secretary's 
method--and 20 used another method.[Footnote 23] 

* Officials from 18 programs reported having conducted an analysis to 
assess whether any cost savings were realized as a result of their 
state's premium assistance program. Twelve programs submitted 
documentation that showed cost savings relative to direct coverage, 
but we could not calculate average savings due to differences in the 
types of documentation provided. 

Enclosure IV provides additional information about expenditures for 
and cost-effectiveness policies in states' premium assistance programs. 

Challenges Officials Reported to Program Implementation and Operation, 
and the Effect of CHIPRA: 

* Program officials who responded to our survey identified several 
challenges to premium assistance program implementation and operation. 
The two most frequently identified challenges were a limited number of 
individuals with access to private health insurance (18 programs), and 
difficulty identifying individuals with access to private health 
insurance (17 programs). 

* Officials from 13 programs reported that the provisions in CHIPRA 
would have an effect on the challenges they identified to premium 
assistance program implementation or operation. For example, officials 
from 9 of the 13 programs specifically noted that the CHIPRA provision 
making eligibility for premium assistance a qualifying event for 
enrollment in a group health plan would have an effect on the 
challenges; officials from some of the programs noted that this 
provision will make it easier to enroll individuals in the premium 
assistance program. 

* Officials from 11 programs reported that they were planning or 
considering premium assistance program changes due to CHIPRA. For 
example, officials from 5 of these programs reported that as a result 
of CHIPRA the state may expand their existing programs--by including 
new populations, such as CHIP-eligible individuals, or expanding 
benefits, such as adding benefits wraparound coverage for dental 
services. 

Enclosure V provides additional information about challenges states 
reported about implementing and operating their premium assistance 
programs. 

Agency Comments: 

We provided a draft of this report to HHS for comment, which in turn 
provided us with written comments from CMS (see enclosure VI). 
Overall, CMS commended GAO's data collection efforts and noted that 
the data will provide a useful baseline to inform Congress and other 
stakeholders about Medicaid-and CHIP-funded premium assistance 
programs. CMS noted that while it did due diligence to verify the 
accuracy of the information we presented in the report, the agency was 
unable to verify all of the data reported by the state officials who 
responded to our Web-based survey. As we explained in the description 
of our methodology, this report presents information provided to us by 
the state officials identified as primary contacts for each premium 
assistance program; we did not ask CMS to verify states' responses. 
Finally, in its comments, CMS summarized some of the findings from our 
draft report, including information on state premium assistance 
program operating authorities and the extent to which programs 
provided benefits wraparound coverage. We have updated these data in 
our final report based upon further clarification we received from 
state officials. CMS also provided technical comments, which we 
incorporated as appropriate. 

We are sending copies of this report to the Administrator of CMS and 
other interested parties. In addition, the report is available at no 
charge on the GAO Web site at [hyperlink, http://www.gao.gov]. 

If you or your staff have any questions about this report, please 
contact me at (202) 512-7114 or yocomc@gao.gov. Contact points for our 
Offices of Congressional Relations and Public Affairs may be found on 
the last page of this report. GAO staff who made major contributions 
to this report are listed in enclosure VII. 

Signed by: 

Carolyn L. Yocom: 
Acting Director, Health Care: 

Enclosures - 7: 

[End of section] 

Enclosure I: States' Premium Assistance Programs' Funding Source, 
Operating Authority, and Type of Insurance Coverage Subsidized: 

Table 2: Program Name, Implementation Year, and Source of Federal 
Funds, by State Premium Assistance Program, 2009: 

State: Alabama; 
Program name: Health Insurance Premium Program; 
Implementation year: 1993; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Alaska; 
Program name: Health Insurance Premium Payments; 
Implementation year: 2006; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: Federal funding source used. 

State: Arizona; 
Program name: Employer Sponsored Insurance Program; 
Implementation year: 2008; 
Federal funding source: Medicaid: [Empty]; 
Federal funding source: CHIP: Federal funding source used. 

State: California; 
Program name: Health Insurance Premium Payment; 
Implementation year: 1989; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Colorado-1; 
Program name: CHP+ at Work; 
Implementation year: 2007; 
Federal funding source: Medicaid: [Empty]; 
Federal funding source: CHIP: Federal funding source used. 

State: Colorado-2; 
Program name: Health Insurance Buy-In; 
Implementation year: 1992; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Florida; 
Program name: Medicaid Reform Opt Out Program; 
Implementation year: 2006; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Georgia; 
Program name: Medicaid Health Insurance Premium Payment Program; 
Implementation year: 1994; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Idaho-1; 
Program name: Children's Access Card; 
Implementation year: 2004; 
Federal funding source: Medicaid: [Empty]; 
Federal funding source: CHIP: Federal funding source used. 

State: Idaho-2; 
Program name: Access to Health Insurance; 
Implementation year: 2005; 
Federal funding source: Medicaid: [Empty]; 
Federal funding source: CHIP: Federal funding source used. 

State: Illinois; 
Program name: Health Insurance Premium Payment Program; 
Implementation year: 1994; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Iowa; 
Program name: Health Insurance Premium Payment Program; 
Implementation year: 1991; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Kansas; 
Program name: Health Insurance Premium Payment System; 
Implementation year: 1991; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Kentucky; 
Program name: Health Insurance Premium Payment Program; 
Implementation year: 1994; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Louisiana; 
Program name: Health Insurance Premium Assistance Program; 
Implementation year: 1991; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: Federal funding source used. 

State: Maine; 
Program name: Private Health Insurance Premium; 
Implementation year: 1992; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Massachusetts-1; 
Program name: MassHealth Premium Assistance; 
Implementation year: 1997; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: Federal funding source used. 

State: Massachusetts-2; 
Program name: Medical Security Program; 
Implementation year: 1997; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Minnesota; 
Program name: Cost-effective health insurance reviews for Medical 
Assistance; 
Implementation year: 1990; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Missouri; 
Program name: Health Insurance Premium Payment Program; 
Implementation year: 1992; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Montana; 
Program name: Health Insurance Premium Payment; 
Implementation year: 1992; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Nebraska; 
Program name: Health Insurance Premium Payment Program; 
Implementation year: 1994; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Nevada-1; 
Program name: Check Up Plus; 
Implementation year: 2006; 
Federal funding source: Medicaid: [Empty]; 
Federal funding source: CHIP: Federal funding source used. 

State: Nevada-2; 
Program name: Health Insurance Premium Program; 
Implementation year: 1992; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: New Hampshire; 
Program name: Health Insurance Premium Payment Program; 
Implementation year: 1991; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: New Jersey-1; 
Program name: Payment of Premiums Program; 
Implementation year: 1993; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: New Jersey-2; 
Program name: Premium Support Program; 
Implementation year: 2001; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: Federal funding source used. 

State: New York; 
Program name: Employer Sponsored Health Insurance Initiative; 
Implementation year: 2008; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: North Dakota; 
Program name: Cost Effective Employer-Based Group Health Plans; 
Implementation year: 1993; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: Federal funding source used. 

State: Oklahoma; 
Program name: Insure Oklahoma/Oklahoma Employer and Employee 
Partnership for Insurance Coverage (O-EPIC); 
Implementation year: 2006; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Oregon-1; 
Program name: Family Health Insurance Assistance Program (FHIAP); 
Implementation year: 2002; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: Federal funding source used. 

State: Oregon-2; 
Program name: Health Insurance Premium Payment/Private Health 
Insurance Premium Payment; 
Implementation year: 1992; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Pennsylvania; 
Program name: Health Insurance Premium Payment Program; 
Implementation year: 1994; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Rhode Island; 
Program name: RIte Share; 
Implementation year: 2001; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: Federal funding source used. 

State: South Carolina; 
Program name: Health Insurance Premium Payment; 
Implementation year: 1994; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: South Dakota; 
Program name: Private Health Insurance Premium Payment; 
Implementation year: 2000; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Texas; 
Program name: Health Insurance Premium Payment Program; 
Implementation year: 1994; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Utah-1; 
Program name: Premium Partnership for Health Insurance; 
Implementation year: 2003; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: Federal funding source used. 

State: Utah-2; 
Program name: Medicaid Operations Buyout Program; 
Implementation year: 1990; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Vermont; 
Program name: Catamount Health & Employer-sponsored premium assistance; 
Implementation year: 2007; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Virginia-1; 
Program name: Family Access to Medical Insurance Security (FAMIS) 
Select; 
Implementation year: 2005; 
Federal funding source: Medicaid: [Empty]; 
Federal funding source: CHIP: Federal funding source used. 

State: Virginia-2; 
Program name: Health Insurance Premium Payment; 
Implementation year: 1993; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Washington; 
Program name: Premium Payment Program; 
Implementation year: 1988; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Wisconsin; 
Program name: BadgerCare Health Insurance Premium Program; 
Implementation year: 2001; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: Federal funding source used. 

State: Wyoming; 
Program name: Health Insurance Premium Payment Program; 
Implementation year: 1993; 
Federal funding source: Medicaid: Federal funding source used; 
Federal funding source: CHIP: [Empty]. 

State: Total; 
Program name: [Empty]; 
Implementation year: [Empty]; 
Federal funding source: Medicaid: 39; 
Federal funding source: CHIP: 15. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, State Children's Health 
Insurance Program (CHIP), or both. We received responses from 
officials representing 45 programs in 37 states; officials from 2 
states with premium assistance programs, North Carolina and West 
Virginia, did not respond to the survey. 

[End of table] 

Table 3: Operating Authority, by State Premium Assistance Program, 
2009: 

State[A]: Alabama; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Alaska; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Arizona; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: California; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Colorado-1; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Colorado-2; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: Operating authority used[D]. 

State[A]: Florida; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Georgia; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Idaho-1; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Idaho-2; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Illinois; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Iowa; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: Operating authority used[E]. 

State[A]: Kansas; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Kentucky; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Louisiana; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Maine; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Massachusetts-1; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: Operating authority used; 
Other: [Empty]. 

State[A]: Massachusetts-2; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Minnesota; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: Operating authority used[E]. 

State[A]: Missouri; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Montana; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Nebraska; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Nevada-1; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Nevada-2; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: New Hampshire; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: New Jersey-1; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: Operating authority used[E]. 

State[A]: New Jersey-2; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: New York; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: North Dakota; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: Operating authority used[D,E]. 

State[A]: Oklahoma; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Oregon-1; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Oregon-2; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Pennsylvania; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Rhode Island; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: South Carolina; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: Operating authority used[D]. 

State[A]: South Dakota; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: Operating authority used[F]. 

State[A]: Texas; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Utah-1; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Utah-2; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: Operating authority used[E]. 

State[A]: Vermont; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Virginia-1; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Virginia-2; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Washington; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: Operating authority used[D,E]. 

State[A]: Wisconsin; 
Section 1906 of the SSA[B]: [Empty]; 
Section 1115 waiver: Operating authority used; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Wyoming; 
Section 1906 of the SSA[B]: Operating authority used; 
Section 1115 waiver: [Empty]; 
Section 2105(c)(3) of the SSA[C]: [Empty]; 
Other: [Empty]. 

State[A]: Total; 
Section 1906 of the SSA[B]: 29; 
Section 1115 waiver: 16; 
Section 2105(c)(3) of the SSA[C]: 1; 
Other: 9. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, CHIP, or both. We received 
responses from officials representing 45 programs in 37 states; 
officials from 2 states with premium assistance programs, North 
Carolina and West Virginia, did not respond to the survey. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[B] SSA is an abbreviation for the Social Security Act. 

[C] Section 2105(c)(3) of the SSA permits payment to a state for 
family coverage under a group health plan or health insurance 
coverage. Regulations at 42 C.F.R. §457.1010 implement the provisions 
of the statute related to family coverage. 42 C.F.R § 457.10 
implements requirements related to premium assistance programs in 
connection with group health plan coverage. For this report, we 
consider programs operated under either authority to be premium 
assistance programs. 

[D] These programs also operated under the authority of section 
1902(a)(10)(F) of the SSA, which allows states to use Medicaid funds 
to pay premiums for COBRA continuation coverage. COBRA, an acronym for 
the Consolidated Omnibus Budget Reconciliation Act of 1985, allows 
employees the opportunity to remain in their employer's group coverage 
when they would otherwise lose coverage. 

[E] Officials representing this program also reported that the program 
operated under the authority of section 1905(a) of the SSA, which 
allows states to use Medicaid funds for the cost of insurance premiums 
for certain Medicaid-eligible individuals. 

[F] According to state officials, this program operated under the 
authority of section 1903(a)(7) of the SSA, which allows for federal 
funding for the proper and efficient administration of states' 
Medicaid programs. 

[End of table] 

Table 4: Type of Private Health Insurance Coverage Subsidized, by 
State Premium Assistance Program, 2009: 

State[A]: Alabama; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: [Empty]. 

State[A]: Alaska; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: [Empty]; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: [Empty]. 

State[A]: Arizona; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: [Empty]; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: California; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: Coverage subsidized. 

State[A]: Colorado-1; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: [Empty]; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Colorado-2; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: Coverage subsidized. 

State[A]: Florida; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Georgia; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: Coverage subsidized. 

State[A]: Idaho-1; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: [Empty]; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: Coverage subsidized. 

State[A]: Idaho-2; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: [Empty]; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Illinois; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: Coverage subsidized. 

State[A]: Iowa; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: Coverage subsidized. 

State[A]: Kansas; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Kentucky; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: [Empty]; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Louisiana; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Maine; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: Coverage subsidized. 

State[A]: Massachusetts-1; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Massachusetts-2; 
Group health insurance coverage: Employer-sponsored: [Empty]; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: Coverage subsidized. 

State[A]: Minnesota; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: Coverage subsidized. 

State[A]: Missouri; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: Coverage subsidized. 

State[A]: Montana; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: Coverage subsidized. 

State[A]: Nebraska; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: Coverage subsidized. 

State[A]: Nevada-1; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: [Empty]; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Nevada-2; 
Group health insurance coverage: Employer-sponsored: [Empty]; 
Group health insurance coverage: COBRA[B]: [Empty]; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: [Empty]. 

State[A]: New Hampshire; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: Coverage subsidized. 

State[A]: New Jersey-1; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: Coverage subsidized. 

State[A]: New Jersey-2; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: [Empty]; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: New York; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: North Dakota; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: Coverage subsidized. 

State[A]: Oklahoma; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: [Empty]; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Oregon-1; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: Coverage subsidized. 

State[A]: Oregon-2; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Pennsylvania; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Rhode Island; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: [Empty]. 

State[A]: South Carolina; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: Coverage subsidized. 

State[A]: South Dakota; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: Coverage subsidized. 

State[A]: Texas; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Utah-1; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: [Empty]; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Utah-2; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: Coverage subsidized. 

State[A]: Vermont[C]; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Virginia-1; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: Coverage subsidized. 

State[A]: Virginia-2; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Washington; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: Coverage subsidized; 
Group health insurance coverage: Other group coverage: Coverage 
subsidized; 
Nongroup coverage: Coverage subsidized. 

State[A]: Wisconsin; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: [Empty]; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Wyoming; 
Group health insurance coverage: Employer-sponsored: Coverage 
subsidized; 
Group health insurance coverage: COBRA[B]: [Empty]; 
Group health insurance coverage: Other group coverage: [Empty]; 
Nongroup coverage: [Empty]. 

State[A]: Total; 
Group health insurance coverage: Employer-sponsored: 43; 
Group health insurance coverage: COBRA[B]: 32; 
Group health insurance coverage: Other group coverage: 17; 
Nongroup coverage: 21. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, CHIP, or both. We received 
responses from officials representing 45 programs in 37 states; 
officials from 2 states with premium assistance programs, North 
Carolina and West Virginia, did not respond to the survey. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[B] COBRA, an acronym for the Consolidated Omnibus Budget 
Reconciliation Act of 1985, allows employees the opportunity to remain 
in their employer's group coverage when they would otherwise lose 
coverage. 

[C] Officials representing this program indicated that the program 
also subsidized premiums for "Catamount Health," a state-sponsored 
program in the nongroup market. 

[End of table] 

Table 5: State Premium Assistance Programs with Employer Contribution 
or Size Requirements, 2009: 

State[A]: Arizona; 
Minimum employer contribution: 30 percent; 
Limits on participation based on employer size: No requirement. 

State[A]: Colorado-1; 
Minimum employer contribution: 50 percent; 
Limits on participation based on employer size: No requirement. 

State[A]: Idaho-2; 
Minimum employer contribution: 50 percent[B]; 
Limits on participation based on employer size: 2 to 50 employees. 

State[A]: Massachusetts-1; 
Minimum employer contribution: 50 percent[C]; 
Limits on participation based on employer size: No requirement. 

State[A]: Nevada-1; 
Minimum employer contribution: 50 percent[B]; 
Limits on participation based on employer size: 2 to 50 employees. 

State[A]: New Jersey-2; 
Minimum employer contribution: 50 percent; 
Limits on participation based on employer size: 2 or more employees. 

State[A]: Oklahoma; 
Minimum employer contribution: 25 percent[B]; 
Limits on participation based on employer size: Less than 100 
employees. 

State[A]: South Dakota; 
Minimum employer contribution: No requirement; 
Limits on participation based on employer size: [D]. 

State[A]: Utah-1; 
Minimum employer contribution: 50 percent[B]; 
Limits on participation based on employer size: No requirement. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, CHIP, or both. We received 
responses from officials representing 45 programs in 37 states; 
officials from 2 states with premium assistance programs, North 
Carolina and West Virginia, did not respond to the survey. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[B] The survey response indicated that the minimum employer 
contribution applied to the premium for the employee, while other 
responses did not make this distinction. 

[C] The employer contribution requirement pertained only to certain 
groups covered by Massachusetts' premium assistance program, 
specifically children and childless adults. 

[D] Officials from this program indicated that the program had a 
requirement on employer size, but did not indicate the limit on the 
size of employers. 

[End of table] 

Table 6: State Premium Assistance Programs with Data on the Number of 
Employers Participating, June 30, 2009: 

State[A]: Colorado-1; 
Employer size: Fewer than 50 employees: Response not provided; 
Employer size: 50 to 199 employees: Response not provided; 
Employer size: 200 or more employees: 1; 
Total employers: 1. 

State[A]: Florida; 
Employer size: Fewer than 50 employees: 1; 
Employer size: 50 to 199 employees: Response not provided; 
Employer size: 200 or more employees: Response not provided; 
Total employers: Response not provided. 

State[A]: Idaho-2; 
Employer size: Fewer than 50 employees: 121; 
Employer size: 50 to 199 employees: NA; 
Employer size: 200 or more employees: NA; 
Total employers: 121. 

State[A]: Nevada-1; 
Employer size: Fewer than 50 employees: 27; 
Employer size: 50 to 199 employees: NA; 
Employer size: 200 or more employees: NA; 
Total employers: 27. 

State[A]: Oklahoma; 
Employer size: Fewer than 50 employees: 4,529; 
Employer size: 50 to 199 employees: 223; 
Employer size: 200 or more employees: NA; 
Total employers: 4,752. 

State[A]: Texas; 
Employer size: Fewer than 50 employees: [B]; 
Employer size: 50 to 199 employees: [B]; 
Employer size: 200 or more employees: [B]; 
Total employers: 3,500[C]. 

State[A]: Washington; 
Employer size: Fewer than 50 employees: [B]; 
Employer size: 50 to 199 employees: [B]; 
Employer size: 200 or more employees: [B]; 
Total employers: 782[D]. 

State[A]: Wisconsin; 
Employer size: Fewer than 50 employees: [B]; 
Employer size: 50 to 199 employees: [B]; 
Employer size: 200 or more employees: [B]; 
Total employers: 172[E]. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

NA = not applicable. The program does not allow participation by 
employers of this size. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, CHIP, or both. We received 
responses from officials representing 45 programs in 37 states; 
officials from 2 states with premium assistance programs, North 
Carolina and West Virginia, did not respond to the survey. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[B] Officials with these programs reported that data by employer size 
were not available. 

[C] Program officials reported the total number of employers as of 
August 24, 2009. 

[D] Program officials reported the total number of employers as of 
June 26, 2009. 

[E] Program officials reported the total number of employers as of 
June 30, 2008. 

[End of table] 

[End of Enclosure I] 

Enclosure II: States' Premium Assistance Programs' Policies Regarding 
Eligibility and Enrollment: 

Table 7: Income Eligibility Standards as a Percentage of the Federal 
Poverty Level (FPL) and State Subsidy of Premiums for Noneligible 
Family Members, by State Premium Assistance Program, June 30, 2009: 

State[A]: Alabama; 
Children: Under age 1 year: 0-133; 
Children: Ages 1 through 5 years: 0-133; 
Children: Ages 6 through 18 years: 0-100; 
Children: Pregnant women/unborn children[B]: 0-133; 
Children: Parents/legal guardians: 0-11; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Alaska; 
Children: Under age 1 year: 150-185; 
Children: Ages 1 through 5 years: 150-185; 
Children: Ages 6 through 18 years: 150-185; 
Children: Pregnant women/unborn children[B]: 150-185; 
Children: Parents/legal guardians: 150-185; 
Children: Childless adults: 150-185; 
Children: Other individuals[C]: 100-250; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Arizona; 
Children: Under age 1 year: 140-200; 
Children: Ages 1 through 5 years: 133-200; 
Children: Ages 6 through 18 years: 100-200; 
Children: Pregnant women/unborn children[B]: Population not covered; 
Children: Parents/legal guardians: Population not covered; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: California; 
Children: Under age 1 year: response not provided; 
Children: Ages 1 through 5 years: response not provided; 
Children: Ages 6 through 18 years: response not provided; 
Children: Pregnant women/unborn children[B]: response not provided; 
Children: Parents/legal guardians: response not provided; 
Children: Childless adults: response not provided; 
Children: Other individuals[C]: response not provided; 
Subsidize premiums for noneligible family members[D]: No. 

State[A]: Colorado-1; 
Children: Under age 1 year: 134-205; 
Children: Ages 1 through 5 years: 134-205; 
Children: Ages 6 through 18 years: 100-205; 
Children: Pregnant women/unborn children[B]: 134-205; 
Children: Parents/legal guardians: Population not covered; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Colorado-2; 
Children: Under age 1 year: 0-133; 
Children: Ages 1 through 5 years: 0-133; 
Children: Ages 6 through 18 years: 0-100; 
Children: Pregnant women/unborn children[B]: 0-133; 
Children: Parents/legal guardians: 0-60; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Florida; 
Children: Under age 1 year: response not provided; 
Children: Ages 1 through 5 years: response not provided; 
Children: Ages 6 through 18 years: response not provided; 
Children: Pregnant women/unborn children[B]: response not provided; 
Children: Parents/legal guardians: response not provided; 
Children: Childless adults: response not provided; 
Children: Other individuals[C]: response not provided; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Georgia; 
Children: Under age 1 year: response not provided; 
Children: Ages 1 through 5 years: response not provided; 
Children: Ages 6 through 18 years: response not provided; 
Children: Pregnant women/unborn children[B]: response not provided; 
Children: Parents/legal guardians: response not provided; 
Children: Childless adults: response not provided; 
Children: Other individuals[C]: response not provided; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Idaho-1; 
Children: Under age 1 year: 133-185; 
Children: Ages 1 through 5 years: 133-185; 
Children: Ages 6 through 18 years: 100-185; 
Children: Pregnant women/unborn children[B]: Population not covered; 
Children: Parents/legal guardians: Population not covered; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: No. 

State[A]: Idaho-2; 
Children: Under age 1 year: Population not covered; 
Children: Ages 1 through 5 years: Population not covered; 
Children: Ages 6 through 18 years: Population not covered; 
Children: Pregnant women/unborn children[B]: 133-185; 
Children: Parents/legal guardians: 25-185; 
Children: Childless adults: 0-185; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: No. 

State[A]: Illinois; 
Children: Under age 1 year: 0-200; 
Children: Ages 1 through 5 years: 0-133; 
Children: Ages 6 through 18 years: 0-133; 
Children: Pregnant women/unborn children[B]: 0-200; 
Children: Parents/legal guardians: 0-133; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: 0-100; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Iowa; 
Children: Under age 1 year: 0-200; 
Children: Ages 1 through 5 years: 0-133; 
Children: Ages 6 through 18 years: 0-133; 
Children: Pregnant women/unborn children[B]: 0-200; 
Children: Parents/legal guardians: 0-133; 
Children: Childless adults: 0-133; 
Children: Other individuals[C]: 0-250; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Kansas; 
Children: Under age 1 year: 100-150; 
Children: Ages 1 through 5 years: 100-149; 
Children: Ages 6 through 18 years: 100-132; 
Children: Pregnant women/unborn children[B]: Population not covered; 
Children: Parents/legal guardians: Population not covered; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Kentucky; 
Children: Under age 1 year: response not provided; 
Children: Ages 1 through 5 years: response not provided; 
Children: Ages 6 through 18 years: response not provided; 
Children: Pregnant women/unborn children[B]: response not provided; 
Children: Parents/legal guardians: response not provided; 
Children: Childless adults: response not provided; 
Children: Other individuals[C]: response not provided; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Louisiana; 
Children: Under age 1 year: 0-250; 
Children: Ages 1 through 5 years: 0-250; 
Children: Ages 6 through 18 years: 0-250; 
Children: Pregnant women/unborn children[B]: 0-200; 
Children: Parents/legal guardians: 0-250; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Maine; 
Children: Under age 1 year: 0-185; 
Children: Ages 1 through 5 years: 0-150; 
Children: Ages 6 through 18 years: 0-150; 
Children: Pregnant women/unborn children[B]: 0-200; 
Children: Parents/legal guardians: 0-200; 
Children: Childless adults: 0-100; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Massachusetts-1; 
Children: Under age 1 year: 0-300; 
Children: Ages 1 through 5 years: 0-300; 
Children: Ages 6 through 18 years: 0-300; 
Children: Pregnant women/unborn children[B]: 0-200; 
Children: Parents/legal guardians: 0-133; 
Children: Childless adults: 0-200; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: No. 

State[A]: Massachusetts-2; 
Children: Under age 1 year: Population not covered; 
Children: Ages 1 through 5 years: Population not covered; 
Children: Ages 6 through 18 years: Population not covered; 
Children: Pregnant women/unborn children[B]: Population not covered; 
Children: Parents/legal guardians: Population not covered; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: 0-400; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Minnesota; 
Children: Under age 1 year: 0-275; 
Children: Ages 1 through 5 years: 0-150; 
Children: Ages 6 through 18 years: 0-150; 
Children: Pregnant women/unborn children[B]: 0-275; 
Children: Parents/legal guardians: 0-100; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: 0-100; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Missouri; 
Children: Under age 1 year: 0-299; 
Children: Ages 1 through 5 years: 0-299; 
Children: Ages 6 through 18 years: 0-299; 
Children: Pregnant women/unborn children[B]: 0-185; 
Children: Parents/legal guardians: response not provided; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: 0-85; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Montana; 
Children: Under age 1 year: 0-133; 
Children: Ages 1 through 5 years: 0-133; 
Children: Ages 6 through 18 years: 0-100; 
Children: Pregnant women/unborn children[B]: 0-150; 
Children: Parents/legal guardians: 0-40; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: 0-58; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Nebraska; 
Children: Under age 1 year: response not provided; 
Children: Ages 1 through 5 years: response not provided; 
Children: Ages 6 through 18 years: response not provided; 
Children: Pregnant women/unborn children[B]: response not provided; 
Children: Parents/legal guardians: response not provided; 
Children: Childless adults: response not provided; 
Children: Other individuals[C]: response not provided; 
Subsidize premiums for noneligible family members[D]: No. 

State[A]: Nevada-1; 
Children: Under age 1 year: 133-200; 
Children: Ages 1 through 5 years: 133-200; 
Children: Ages 6 through 18 years: 100-200; 
Children: Pregnant women/unborn children[B]: Population not covered; 
Children: Parents/legal guardians: 100-200; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: 100-200; 
Subsidize premiums for noneligible family members[D]: No. 

State[A]: Nevada-2; 
Children: Under age 1 year: 0-133; 
Children: Ages 1 through 5 years: 0-133; 
Children: Ages 6 through 18 years: 0-100; 
Children: Pregnant women/unborn children[B]: 0-185; 
Children: Parents/legal guardians: 0-130; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: 133-185; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: New Hampshire; 
Children: Under age 1 year: 0-185; 
Children: Ages 1 through 5 years: 0-185; 
Children: Ages 6 through 18 years: 0-185; 
Children: Pregnant women/unborn children[B]: 133-185; 
Children: Parents/legal guardians: Population not covered; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: New Jersey-1; 
Children: Under age 1 year: response not provided; 
Children: Ages 1 through 5 years: response not provided; 
Children: Ages 6 through 18 years: response not provided; 
Children: Pregnant women/unborn children[B]: response not provided; 
Children: Parents/legal guardians: response not provided; 
Children: Childless adults: response not provided; 
Children: Other individuals[C]: response not provided; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: New Jersey-2; 
Children: Under age 1 year: 0-350; 
Children: Ages 1 through 5 years: 0-350; 
Children: Ages 6 through 18 years: 0-350; 
Children: Pregnant women/unborn children[B]: Population not covered; 
Children: Parents/legal guardians: 0-200; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: No. 

State[A]: New York; 
Children: Under age 1 year: Population not covered; 
Children: Ages 1 through 5 years: Population not covered; 
Children: Ages 6 through 18 years: Population not covered; 
Children: Pregnant women/unborn children[B]: Population not covered; 
Children: Parents/legal guardians: 0-150; 
Children: Childless adults: 0-100; 
Children: Other individuals[C]: 0-150; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: North Dakota; 
Children: Under age 1 year: 0-133; 
Children: Ages 1 through 5 years: 0-133; 
Children: Ages 6 through 18 years: 0-100; 
Children: Pregnant women/unborn children[B]: 0-133; 
Children: Parents/legal guardians: 0-83; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: 0-225; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Oklahoma; 
Children: Under age 1 year: Population not covered; 
Children: Ages 1 through 5 years: Population not covered; 
Children: Ages 6 through 18 years: Population not covered; 
Children: Pregnant women/unborn children[B]: 0-200; 
Children: Parents/legal guardians: 0-200; 
Children: Childless adults: 0-200; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: No. 

State[A]: Oregon-1; 
Children: Under age 1 year: 0-185; 
Children: Ages 1 through 5 years: 0-185; 
Children: Ages 6 through 18 years: 0-185; 
Children: Pregnant women/unborn children[B]: 0-185; 
Children: Parents/legal guardians: 0-185; 
Children: Childless adults: 0-185; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: No. 

State[A]: Oregon-2; 
Children: Under age 1 year: 0-185; 
Children: Ages 1 through 5 years: 0-133; 
Children: Ages 6 through 18 years: 0-100; 
Children: Pregnant women/unborn children[B]: 0-185; 
Children: Parents/legal guardians: 0-41; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Pennsylvania; 
Children: Under age 1 year: response not provided; 
Children: Ages 1 through 5 years: response not provided; 
Children: Ages 6 through 18 years: response not provided; 
Children: Pregnant women/unborn children[B]: response not provided; 
Children: Parents/legal guardians: response not provided; 
Children: Childless adults: response not provided; 
Children: Other individuals[C]: response not provided; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Rhode Island; 
Children: Under age 1 year: 0-250; 
Children: Ages 1 through 5 years: 0-250; 
Children: Ages 6 through 18 years: 0-250; 
Children: Pregnant women/unborn children[B]: 0-250; 
Children: Parents/legal guardians: 0-185; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: South Carolina; 
Children: Under age 1 year: response not provided; 
Children: Ages 1 through 5 years: response not provided; 
Children: Ages 6 through 18 years: response not provided; 
Children: Pregnant women/unborn children[B]: response not provided; 
Children: Parents/legal guardians: response not provided; 
Children: Childless adults: response not provided; 
Children: Other individuals[C]: response not provided; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: South Dakota; 
Children: Under age 1 year: 0-140; 
Children: Ages 1 through 5 years: 0-140; 
Children: Ages 6 through 18 years: 0-140; 
Children: Pregnant women/unborn children[B]: 0-133; 
Children: Parents/legal guardians: 0-52; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: No. 

State[A]: Texas; 
Children: Under age 1 year: 0-185; 
Children: Ages 1 through 5 years: 0-133; 
Children: Ages 6 through 18 years: 0-100; 
Children: Pregnant women/unborn children[B]: 0-185; 
Children: Parents/legal guardians: 0-13; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Utah-1; 
Children: Under age 1 year: 133-200; 
Children: Ages 1 through 5 years: 133-200; 
Children: Ages 6 through 18 years: 0-200; 
Children: Pregnant women/unborn children[B]: Population not covered; 
Children: Parents/legal guardians: 0-150; 
Children: Childless adults: 0-150; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: No. 

State[A]: Utah-2; 
Children: Under age 1 year: 0-133; 
Children: Ages 1 through 5 years: 0-133; 
Children: Ages 6 through 18 years: 0-100; 
Children: Pregnant women/unborn children[B]: 0-133; 
Children: Parents/legal guardians: 0-42; 
Children: Childless adults: 0-150; 
Children: Other individuals[C]: 0-185; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Vermont; 
Children: Under age 1 year: Population not covered; 
Children: Ages 1 through 5 years: Population not covered; 
Children: Ages 6 through 18 years: Population not covered; 
Children: Pregnant women/unborn children[B]: Population not covered; 
Children: Parents/legal guardians: 0-200; 
Children: Childless adults: 0-200; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: No. 

State[A]: Virginia-1; 
Children: Under age 1 year: 134-200; 
Children: Ages 1 through 5 years: 134-200; 
Children: Ages 6 through 18 years: 134-200; 
Children: Pregnant women/unborn children[B]: Population not covered; 
Children: Parents/legal guardians: Population not covered; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Virginia-2; 
Children: Under age 1 year: 0-133; 
Children: Ages 1 through 5 years: 0-133; 
Children: Ages 6 through 18 years: 0-133; 
Children: Pregnant women/unborn children[B]: 0-133; 
Children: Parents/legal guardians: 0-30; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Washington; 
Children: Under age 1 year: 0-200; 
Children: Ages 1 through 5 years: 0-200; 
Children: Ages 6 through 18 years: 0-200; 
Children: Pregnant women/unborn children[B]: 0-185; 
Children: Parents/legal guardians: 0-79; 
Children: Childless adults: 0-100; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Wisconsin; 
Children: Under age 1 year: 0-250; 
Children: Ages 1 through 5 years: 0-250; 
Children: Ages 6 through 18 years: 0-250; 
Children: Pregnant women/unborn children[B]: 0-300; 
Children: Parents/legal guardians: 0-200; 
Children: Childless adults: 0-200; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

State[A]: Wyoming; 
Children: Under age 1 year: 0-133; 
Children: Ages 1 through 5 years: 0-133; 
Children: Ages 6 through 18 years: 0-100; 
Children: Pregnant women/unborn children[B]: 0-133; 
Children: Parents/legal guardians: 0-36; 
Children: Childless adults: Population not covered; 
Children: Other individuals[C]: Population not covered; 
Subsidize premiums for noneligible family members[D]: Yes. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, State Children's Health 
Insurance Program (CHIP), or both. We received responses from 
officials representing 45 programs in 37 states; officials from 2 
states with premium assistance programs, North Carolina and West 
Virginia, did not respond to the survey. 

The FPL is updated annually to reflect changes in the cost of living 
and varies according to family size. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[B] Under CHIP, states may choose to extend eligibility to unborn 
children and provide prenatal care and delivery. See 67 Fed. Reg. 
61956 (Oct. 2, 2002). 

[C] Individuals commonly included in this group were certain 
unemployed individuals, aged or disabled individuals, or individuals 
receiving Supplemental Security Income benefits. 

[D] Programs may subsidize premiums (provide incidental coverage) for 
noneligible family members under certain circumstances--for example, 
if the noneligible family member must be enrolled in the health plan 
for the eligible family member to obtain coverage. 

[End of table] 

Figure 1: Number of State Premium Assistance Programs that Set Maximum 
Family Income Eligibility Thresholds within Selected Ranges, Expressed 
as Percentages of the FPL, by Coverage Group, June 30, 2009: 

[Refer to PDF for image: illustrated table] 

Maximum threshold between 301 and 400 percent of the FPL: 
Children under age 1: 1 program; 
Children ages 1 through 5 years: 1 program; 
Children ages 6 through 18 years: 1 program; 
Pregnant women/unborn children[A]: 0; 
Parents/legal guardians: 0; 
Childless adults: 0; 
Other individuals[B]: 1 program. 

Maximum threshold between 201 and 300 percent of the FPL: 
Children under age 1: 7 programs; 
Children ages 1 through 5 years: 6 programs; 
Children ages 6 through 18 years: 6 programs; 
Pregnant women/unborn children[A]: 4 programs; 
Parents/legal guardians: 1 program; 
Childless adults: 0; 
Other individuals[B]: 3 programs. 

Maximum threshold between 101 and 200 percent of the FPL: 
Children under age 1: 24 programs; 
Children ages 1 through 5 years: 25 programs; 
Children ages 6 through 18 years: 16 programs; 
Pregnant women/unborn children[A]: 23 programs; 
Parents/legal guardians: 16 programs; 
Childless adults: 10 programs; 
Other individuals[B]: 4 programs. 

Maximum threshold at or below 100 percent of the FPL: 
Children under age 1: 0; 
Children ages 1 through 5 years: 0; 
Children ages 6 through 18 years: 9 programs; 
Pregnant women/unborn children[A]: 0; 
Parents/legal guardians: 12 programs; 
Childless adults: 3 programs; 
Other individuals[B]: 4 programs. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, CHIP, or both. We received 
responses from officials representing 45 programs in 37 states; 
officials from 2 states with premium assistance programs, North 
Carolina and West Virginia, did not respond to the survey. Officials 
of 8 premium assistance programs did not provide information on income 
eligibility thresholds. 

The FPL is updated annually to reflect changes in the cost of living 
and varies according to family size. 

[A] Under CHIP, states may choose to extend eligibility to unborn 
children and provide prenatal care and delivery. See 67 Fed. Reg. 
61956 (Oct. 2, 2002). 

[B] Individuals commonly included in this group were certain 
unemployed individuals, aged or disabled individuals, or individuals 
receiving Supplemental Security Income benefits. 

[End of figure] 

Table 8: Enrollment Policies, by State Premium Assistance Program, 
2009: 

State[A]: Alabama; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Alaska; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Arizona; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: 3. 

State[A]: California; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Colorado-1; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Colorado-2; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Florida; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Georgia; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Idaho-1; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: 6. 

State[A]: Idaho-2; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: 6. 

State[A]: Illinois; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Iowa; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Kansas; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Kentucky; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Louisiana; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Maine; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Massachusetts-1; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: 6[E]. 

State[A]: Massachusetts-2; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Minnesota; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Missouri; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Montana; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Nebraska; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Nevada-1; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: 6. 

State[A]: Nevada-2; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: New Hampshire; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: New Jersey-1; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: New Jersey-2; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: Enrollment policy 
used[F]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: 3. 

State[A]: New York; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: North Dakota; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Oklahoma; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Oregon-1; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: 6. 

State[A]: Oregon-2; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Pennsylvania; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Rhode Island; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: South Carolina; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: South Dakota; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Texas; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Utah-1; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: 3. 

State[A]: Utah-2; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [D]. 

State[A]: Vermont; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: 12. 

State[A]: Virginia-1; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: 4. 

State[A]: Virginia-2; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: d. 

State[A]: Washington; 
Mandatory enrollment[B]: Yes, for all individuals: [Empty]; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: Enrollment policy used; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: d. 

State[A]: Wisconsin; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: 3[G]. 

State[A]: Wyoming; 
Mandatory enrollment[B]: Yes, for all individuals: Enrollment policy 
used; 
Mandatory enrollment[B]: Yes, for some individuals: [Empty]; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: [Empty]; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: Response not 
provided. 

State[A]: Total; 
Mandatory enrollment[B]: Yes, for all individuals: 19; 
Mandatory enrollment[B]: Yes, for some individuals: 1; 
Mandatory enrollment[B]: No, enrollment is voluntary for all 
individuals: 25; 
Months individuals are required to be without group health insurance 
before enrollment in premium assistance is permitted[C]: [Empty]. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, CHIP, or both. We received 
responses from officials representing 45 programs in 37 states; 
officials from 2 states with premium assistance programs, North 
Carolina and West Virginia, did not respond to the survey. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[B] Enrollment was considered to be mandatory if individuals who met 
the program's eligibility requirements--which may have included having 
access to cost-effective private health insurance--were required to 
enroll in the premium assistance program in order to get Medicaid or 
CHIP benefits. Although a premium assistance program may have 
mandatory enrollment for all eligible individuals, under section 1906 
of the Social Security Act (SSA), eligible children cannot be denied 
direct coverage if their parent fails to enroll them in a group health 
plan. 

[C] Programs may permit reasonable exceptions. 

[D] This program does not require individuals to be uninsured for any 
period of time before enrolling in premium assistance. 

[E] Officials from this program reported that only children receiving 
premium assistance through CHIP were required to be uninsured for the 
6 months prior to enrollment in premium assistance. 

[F] Officials from this program reported that the program did not have 
mandatory enrollment for individuals with incomes less than 134 
percent of the FPL. 

[G] Officials from this program reported that childless adults were 
required to be uninsured for the 12 months prior to enrollment in 
premium assistance. 

[End of table] 

Table 9: Number of Individuals and Families Covered, by State Premium 
Assistance Program, June 30, 2009: 

State[A]: Alabama; 
Number of Medicaid-or CHIP-eligible individuals[B]: 6; 
Number of noneligible family members[B]: 0; 
Total number of individuals[B]: 6; 
Number of families[C]: 0. 

State[A]: Alaska; 
Number of Medicaid-or CHIP-eligible individuals[B]: 16; 
Number of noneligible family members[B]: 29; 
Total number of individuals[B]: 71[D]; 
Number of families[C]: 14. 

State[A]: Arizona; 
Number of Medicaid-or CHIP-eligible individuals[B]: 3; 
Number of noneligible family members[B]: Response not provided; 
Total number of individuals[B]: 3; 
Number of families[C]: 1. 

State[A]: California; 
Number of Medicaid-or CHIP-eligible individuals[B]: 1,033; 
Number of noneligible family members[B]: [E]; 
Total number of individuals[B]: [F]; 
Number of families[C]: [E]. 

State[A]: Colorado-1; 
Number of Medicaid-or CHIP-eligible individuals[B]: 103; 
Number of noneligible family members[B]: 61; 
Total number of individuals[B]: 164; 
Number of families[C]: 42. 

State[A]: Colorado-2; 
Number of Medicaid-or CHIP-eligible individuals[B]: 432; 
Number of noneligible family members[B]: [E]; 
Total number of individuals[B]: 432; 
Number of families[C]: 403. 

State[A]: Florida; 
Number of Medicaid-or CHIP-eligible individuals[B]: 21; 
Number of noneligible family members[B]: [E]; 
Total number of individuals[B]: [F]; 
Number of families[C]: 13. 

State[A]: Georgia; 
Number of Medicaid-or CHIP-eligible individuals[B]: 937; 
Number of noneligible family members[B]: [E]; 
Total number of individuals[B]: [F]; 
Number of families[C]: 882. 

State[A]: Idaho-1; 
Number of Medicaid-or CHIP-eligible individuals[B]: 133; 
Number of noneligible family members[B]: 0; 
Total number of individuals[B]: 133; 
Number of families[C]: 0. 

State[A]: Idaho-2; 
Number of Medicaid-or CHIP-eligible individuals[B]: 347; 
Number of noneligible family members[B]: 0; 
Total number of individuals[B]: 347; 
Number of families[C]: [E]. 

State[A]: Illinois; 
Number of Medicaid-or CHIP-eligible individuals[B]: 145; 
Number of noneligible family members[B]: e; 
Total number of individuals[B]: [F]; 
Number of families[C]: 67. 

State[A]: Iowa; 
Number of Medicaid-or CHIP-eligible individuals[B]: 3,019; 
Number of noneligible family members[B]: 4,319; 
Total number of individuals[B]: 8,086[D]; 
Number of families[C]: 1,949. 

State[A]: Kansas; 
Number of Medicaid-or CHIP-eligible individuals[B]: [E]; 
Number of noneligible family members[B]: [E]; 
Total number of individuals[B]: [E]; 
Number of families[C]: [E]. 

State[A]: Kentucky; 
Number of Medicaid-or CHIP-eligible individuals[B]: 6; 
Number of noneligible family members[B]: Response not provided; 
Total number of individuals[B]: [F]; 
Number of families[C]: 6. 

State[A]: Louisiana; 
Number of Medicaid-or CHIP-eligible individuals[B]: 2,621; 
Number of noneligible family members[B]: 831; 
Total number of individuals[B]: 3,452; 
Number of families[C]: 743. 

State[A]: Maine; 
Number of Medicaid-or CHIP-eligible individuals[B]: 869; 
Number of noneligible family members[B]: 172; 
Total number of individuals[B]: 1,041; 
Number of families[C]: 314. 

State[A]: Massachusetts-1; 
Number of Medicaid-or CHIP-eligible individuals[B]: 30,653; 
Number of noneligible family members[B]: 0; 
Total number of individuals[B]: 30,653; 
Number of families[C]: 18,397. 

State[A]: Massachusetts-2; 
Number of Medicaid-or CHIP-eligible individuals[B]: 3,500; 
Number of noneligible family members[B]: 2,034; 
Total number of individuals[B]: 5,534; 
Number of families[C]: 3,500. 

State[A]: Minnesota; 
Number of Medicaid-or CHIP-eligible individuals[B]: 20,276; 
Number of noneligible family members[B]: Response not provided; 
Total number of individuals[B]: 20,276; 
Number of families[C]: 6,569. 

State[A]: Missouri; 
Number of Medicaid-or CHIP-eligible individuals[B]: 1,549; 
Number of noneligible family members[B]: 1,297; 
Total number of individuals[B]: 2,846; 
Number of families[C]: 781. 

State[A]: Montana; 
Number of Medicaid-or CHIP-eligible individuals[B]: 747; 
Number of noneligible family members[B]: [E]; 
Total number of individuals[B]: 747; 
Number of families[C]: 267. 

State[A]: Nebraska; 
Number of Medicaid-or CHIP-eligible individuals[B]: 320; 
Number of noneligible family members[B]: 750; 
Total number of individuals[B]: 1,070; 
Number of families[C]: 285. 

State[A]: Nevada-1; 
Number of Medicaid-or CHIP-eligible individuals[B]: 4; 
Number of noneligible family members[B]: 0; 
Total number of individuals[B]: 4; 
Number of families[C]: 4. 

State[A]: Nevada-2; 
Number of Medicaid-or CHIP-eligible individuals[B]: 48; 
Number of noneligible family members[B]: 110; 
Total number of individuals[B]: 158; 
Number of families[C]: e. 

State[A]: New Hampshire; 
Number of Medicaid-or CHIP-eligible individuals[B]: 127; 
Number of noneligible family members[B]: 98; 
Total number of individuals[B]: 229[D]; 
Number of families[C]: 94. 

State[A]: New Jersey-1; 
Number of Medicaid-or CHIP-eligible individuals[B]: 73; 
Number of noneligible family members[B]: 58; 
Total number of individuals[B]: 131; 
Number of families[C]: 64. 

State[A]: New Jersey-2; 
Number of Medicaid-or CHIP-eligible individuals[B]: 300; 
Number of noneligible family members[B]: 0; 
Total number of individuals[B]: 300; 
Number of families[C]: 95. 

State[A]: New York; 
Number of Medicaid-or CHIP-eligible individuals[B]: 1,380; 
Number of noneligible family members[B]: Response not provided; 
Total number of individuals[B]: [F]; 
Number of families[C]: 255. 

State[A]: North Dakota; 
Number of Medicaid-or CHIP-eligible individuals[B]: 54; 
Number of noneligible family members[B]: 24; 
Total number of individuals[B]: 78; 
Number of families[C]: [E]. 

State[A]: Oklahoma; 
Number of Medicaid-or CHIP-eligible individuals[B]: 14,217; 
Number of noneligible family members[B]: e; 
Total number of individuals[B]: 14,217; 
Number of families[C]: [E]. 

State[A]: Oregon-1; 
Number of Medicaid-or CHIP-eligible individuals[B]: 6,692; 
Number of noneligible family members[B]: 0; 
Total number of individuals[B]: 6,692; 
Number of families[C]: 3,506. 

State[A]: Oregon-2; 
Number of Medicaid-or CHIP-eligible individuals[B]: 658; 
Number of noneligible family members[B]: 205; 
Total number of individuals[B]: 863; 
Number of families[C]: [E]. 

State[A]: Pennsylvania; 
Number of Medicaid-or CHIP-eligible individuals[B]: 26,693; 
Number of noneligible family members[B]: [E]; 
Total number of individuals[B]: [F]; 
Number of families[C]: 12,462. 

State[A]: Rhode Island; 
Number of Medicaid-or CHIP-eligible individuals[B]: 8,493; 
Number of noneligible family members[B]: [E]; 
Total number of individuals[B]: 8,493; 
Number of families[C]: [E]. 

State[A]: South Carolina; 
Number of Medicaid-or CHIP-eligible individuals[B]: 215; 
Number of noneligible family members[B]: 40; 
Total number of individuals[B]: 255; 
Number of families[C]: 211. 

State[A]: South Dakota; 
Number of Medicaid-or CHIP-eligible individuals[B]: 70; 
Number of noneligible family members[B]: [E]; 
Total number of individuals[B]: [F]; 
Number of families[C]: [E]. 

State[A]: Texas; 
Number of Medicaid-or CHIP-eligible individuals[B]: 7,822; 
Number of noneligible family members[B]: 849; 
Total number of individuals[B]: 8,671; 
Number of families[C]: 1,351. 

State[A]: Utah-1; 
Number of Medicaid-or CHIP-eligible individuals[B]: 728; 
Number of noneligible family members[B]: 0; 
Total number of individuals[B]: 728; 
Number of families[C]: 331. 

State[A]: Utah-2; 
Number of Medicaid-or CHIP-eligible individuals[B]: 200; 
Number of noneligible family members[B]: 5; 
Total number of individuals[B]: 205; 
Number of families[C]: 200. 

State[A]: Vermont; 
Number of Medicaid-or CHIP-eligible individuals[B]: 6,989; 
Number of noneligible family members[B]: 0; 
Total number of individuals[B]: 6,989; 
Number of families[C]: 0. 

State[A]: Virginia-1; 
Number of Medicaid-or CHIP-eligible individuals[B]: 449; 
Number of noneligible family members[B]: 342; 
Total number of individuals[B]: 791; 
Number of families[C]: 147. 

State[A]: Virginia-2; 
Number of Medicaid-or CHIP-eligible individuals[B]: 2,199; 
Number of noneligible family members[B]: [E]; 
Total number of individuals[B]: [F]; 
Number of families[C]: 1,489. 

State[A]: Washington; 
Number of Medicaid-or CHIP-eligible individuals[B]: [E]; 
Number of noneligible family members[B]: [E]; 
Total number of individuals[B]: 6,041; 
Number of families[C]: 3,393. 

State[A]: Wisconsin; 
Number of Medicaid-or CHIP-eligible individuals[B]: 1,110; 
Number of noneligible family members[B]: [E]; 
Total number of individuals[B]: [F]; 
Number of families[C]: 304. 

State[A]: Wyoming; 
Number of Medicaid-or CHIP-eligible individuals[B]: 8; 
Number of noneligible family members[B]: Response not provided; 
Total number of individuals[B]: 8; 
Number of families[C]: 5. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, CHIP, or both. We received 
responses from officials representing 45 programs in 37 states; 
officials from 2 states with premium assistance programs, North 
Carolina and West Virginia, did not respond to the survey. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[B] The data on the number of individuals enrolled in states' premium 
assistance programs were generally as of June 30, 2009. However, the 
following programs provided data as of a different date: Arizona - 
April 1, 2009; Georgia - July 31, 2009; Maine - August 19, 2009; 
Minnesota - January 1, 2009; Nevada-2 - August 14, 2009; New Hampshire 
- July 17, 2009; Texas - August 24, 2009; Utah-1 - August 1, 2009; 
Washington - June 26, 2009; and Wisconsin - June 30, 2008. 

[C] The data on the number of families enrolled in states' premium 
assistance programs were generally as of June 30, 2009. However, the 
following programs provided data as of a different date: Alaska - July 
31, 2009; Arizona - April 1, 2009; Georgia - July 31, 2009; 
Minnesota - January 1, 2009; New Hampshire - July 17, 2009; Texas - 
August 24, 2009; Utah-1 - August 1, 2009; Virginia-1 - July 1, 2009; 
Washington - June 26, 2009; and Wisconsin - June 30, 2008. 

[D] We have reported the data as they were reported to us in states' 
survey responses even though the data on the number of individuals and 
noneligible family members enrolled in these states' premium 
assistance programs did not equal the data provided on the total 
number of individuals enrolled in the programs. 

[E] According to program officials, data on enrollment were not 
available for the specified category. 

[F] These programs provided data on the number of eligible individuals 
enrolled in premium assistance, but either indicated that data were 
not available on the total number of individuals enrolled in premium 
assistance programs or did not provide data on the total number of 
individuals enrolled in premium assistance programs. 

[End of table] 

[End of Enclosure II] 

Enclosure III: States' Premium Assistance Programs' Benefits, 
Premiums, and Cost Sharing: 

Table 10: Minimum Requirements Programs Have for Private Health 
Insurance Benefit Packages to Qualify for a State Subsidy, by State 
Premium Assistance Program, 2009: 

State[A]: Alabama; 
No requirement: [Empty]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Check][C]. 

State[A]: Alaska; 
No requirement: [Empty]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Empty]. 

State[A]: Arizona; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: California; 
No requirement: [Empty]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Check][D]. 

State[A]: Colorado-1; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Colorado-2; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Florida; 
No requirement: [Empty]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Empty]. 

State[A]: Georgia; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Idaho-1; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Empty]. 

State[A]: Idaho-2; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Empty]. 

State[A]: Illinois; 
No requirement: [Check]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Iowa; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Kansas; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Kentucky; 
No requirement: [Empty]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Louisiana; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Maine; 
No requirement: [Empty]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Empty]. 

State[A]: Massachusetts-1; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Check][E]. 

State[A]: Massachusetts-2; 
No requirement: [Empty]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Empty]. 

State[A]: Minnesota; 
No requirement: [Check]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Missouri; 
No requirement: [Check]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Montana; 
No requirement: [Check]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Nebraska; 
No requirement: [Empty]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Empty]. 

State[A]: Nevada-1; 
No requirement: [Empty]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Empty]. 

State[A]: Nevada-2; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: New Hampshire; 
No requirement: [Empty]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Empty]. 

State[A]: New Jersey-1; 
No requirement: [Empty]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Check][F]. 

State[A]: New Jersey-2; 
No requirement: [Empty]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Check][E]. 

State[A]: New York; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: North Dakota; 
No requirement: [Check]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Oklahoma; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Check]. 

State[A]: Oregon-1; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Check][G]. 

State[A]: Oregon-2; 
No requirement: [Empty]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Empty]. 

State[A]: Pennsylvania; 
No requirement: [Check]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Rhode Island; 
No requirement: [Empty]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Check][H]. 

State[A]: South Carolina; 
No requirement: [Check]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: South Dakota; 
No requirement: [Check]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Texas; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Check][I]. 

State[A]: Utah-1; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Check][I]. 

State[A]: Utah-2; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Check][H]. 

State[A]: Vermont; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Check][J]. 

State[A]: Virginia-1; 
No requirement: [Check]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Virginia-2; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Washington; 
No requirement: [Check]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Wisconsin; 
No requirement: [Empty]; 
Must cover certain services[B]: [Check]; 
Must meet state insurance regulations: [Check]; 
Must meet other requirements: [Empty]. 

State[A]: Wyoming; 
No requirement: [Check]; 
Must cover certain services[B]: [Empty]; 
Must meet state insurance regulations: [Empty]; 
Must meet other requirements: [Empty]. 

State[A]: Total; 
No requirement: 12; 
Must cover certain services[B]: 20; 
Must meet state insurance regulations: 16; 
Must meet other requirements: 12. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Legend: 

[Check] = Requirement. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, State Children's Health 
Insurance Program (CHIP), or both. We received responses from 
officials representing 45 programs in 37 states; officials from 2 
states with premium assistance programs, North Carolina and West 
Virginia, did not respond to the survey. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[B] See table 13 for a list of services required. 

[C] In order to qualify for a state subsidy, the private insurance 
benefit package was required to cover the services needed to treat the 
premium assistance program applicant's high-cost condition. 

[D] In order to qualify for a state subsidy, the private insurance 
benefit package was required to cover the premium assistance program 
applicant's high-cost medical condition and be a comprehensive health 
coverage policy. 

[E] In order to qualify for a state subsidy, the private insurance 
benefit package was required to meet one of the CHIP benchmarks for 
benefit packages. 

[F] At a minimum, the plan was required to cover the services most 
utilized by a client. 

[G] In order to qualify for a state subsidy, the private insurance 
benefit package was required to be actuarially equivalent to federally 
mandated Medicaid benefits. 

[H] In order to qualify for a state subsidy, the private insurance 
benefit package was required to be actuarially equivalent to the 
benefit package eligible individuals would receive under direct 
coverage. 

[I] In order to qualify for a state subsidy, the private insurance 
benefit package was required to offer a lifetime maximum benefit at or 
above a certain amount. 

[J] In order to qualify for a state subsidy, the private insurance 
benefit package must have a deductible of $500 or less. 

[End of table] 

Table 11: Services Programs Require Private Health Insurance Benefit 
Packages to Cover in Order to Qualify for a State Subsidy, by State 
Premium Assistance Program, 2009: 

State[A]: Arizona; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: Service required; 
Mental health: Service required; 
Well-baby and well-child care: Service required; 
Immunizations: Service required; 
Other services: [Empty]. 

State[A]: Colorado-1; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: [Empty]; 
Pharmacy or prescription drugs: [Empty]; 
Mental health: [Empty]; 
Well-baby and well-child care: Service required; 
Immunizations: Service required; 
Other services: [Empty]. 

State[A]: Colorado-2; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: Service required; 
Mental health: [Empty]; 
Well-baby and well-child care: [Empty]; 
Immunizations: [Empty]; 
Other services: Service required. 

State[A]: Georgia; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: Service required; 
Mental health: Service required; 
Well-baby and well-child care: [Empty]; 
Immunizations: [Empty]; 
Other services: [Empty]. 

State[A]: Idaho-1; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: [Empty]; 
Mental health: [Empty]; 
Well-baby and well-child care: [Empty]; 
Immunizations: [Empty]; 
Other services: [Empty]. 

State[A]: Idaho-2; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: Service required; 
Mental health: Service required; 
Well-baby and well-child care: Service required; 
Immunizations: [Empty]; 
Other services: Service required. 

State[A]: Iowa; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: [Empty]; 
Mental health: [Empty]; 
Well-baby and well-child care: [Empty]; 
Immunizations: [Empty]; 
Other services: [Empty]. 

State[A]: Kansas; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: Service required; 
Mental health: [Empty]; 
Well-baby and well-child care: [Empty]; 
Immunizations: [Empty]; 
Other services: [Empty]. 

State[A]: Louisiana; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: Service required; 
Mental health: [Empty]; 
Well-baby and well-child care: [Empty]; 
Immunizations: [Empty]; 
Other services: [Empty]. 

State[A]: Massachusetts-1; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: Service required; 
Mental health: Service required; 
Well-baby and well-child care: Service required; 
Immunizations: Service required; 
Other services: [Empty]. 

State[A]: Nevada-2; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: Service required; 
Mental health: Service required; 
Well-baby and well-child care: Service required; 
Immunizations: Service required; 
Other services: Service required. 

State[A]: New York; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: [Empty]; 
Mental health: Service required; 
Well-baby and well-child care: Service required; 
Immunizations: Service required; 
Other services: Service required. 

State[A]: Oklahoma; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: Service required; 
Mental health: Service required; 
Well-baby and well-child care: [Empty]; 
Immunizations: [Empty]; 
Other services: Service required. 

State[A]: Oregon-1; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: Service required; 
Mental health: Service required; 
Well-baby and well-child care: Service required; 
Immunizations: Service required; 
Other services: Service required. 

State[A]: Texas; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: Service required; 
Mental health: [Empty]; 
Well-baby and well-child care: [Empty]; 
Immunizations: [Empty]; 
Other services: Service required. 

State[A]: Utah-1; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: [Empty]; 
Pharmacy or prescription drugs: Service required; 
Mental health: [Empty]; 
Well-baby and well-child care: Service required; 
Immunizations: Service required; 
Other services: [Empty]. 

State[A]: Utah-2; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: Service required; 
Mental health: Service required; 
Well-baby and well-child care: Service required; 
Immunizations: Service required; 
Other services: [Empty]. 

State[A]: Vermont; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: Service required; 
Mental health: Service required; 
Well-baby and well-child care: [Empty]; 
Immunizations: [Empty]; 
Other services: Service required. 

State[A]: Virginia-2; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: Service required; 
Mental health: [Empty]; 
Well-baby and well-child care: [Empty]; 
Immunizations: Service required; 
Other services: [Empty]. 

State[A]: Wisconsin; 
Inpatient hospital: Service required; 
Physician services: Service required; 
Outpatient hospital: Service required; 
Pharmacy or prescription drugs: [Empty]; 
Mental health: [Empty]; 
Well-baby and well-child care: [Empty]; 
Immunizations: [Empty]; 
Other services: [Empty]. 

State[A]: Total; 
Inpatient hospital: 20; 
Physician services: 20; 
Outpatient hospital: 18; 
Pharmacy or prescription drugs: 15; 
Mental health: 10; 
Well-baby and well-child care: 9; 
Immunizations: 9; 
Other services: 8. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, CHIP, or both. We received 
responses from officials representing 45 programs in 37 states; 
officials from 2 states with premium assistance programs, North 
Carolina and West Virginia, did not respond to the survey. 

Table includes only state premium assistance programs which reported a 
requirement that the private health insurance benefit package cover 
certain services specified by the program to qualify for the state 
subsidy (see table 10). States may cover directly any services to 
which eligible individuals are entitled that are not covered by the 
private health insurance plan; see table 12 for more information. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[End of table] 

Table 12: Level of Benefits Wraparound Provided to Eligible 
Individuals, by State Premium Assistance Program, 2009: 

State[A]: Alabama; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Alaska; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Arizona; 
Complete benefits wraparound provided[B]: No individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: California; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Colorado-1; 
Complete benefits wraparound provided[B]: No individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Colorado-2; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Florida; 
Complete benefits wraparound provided[B]: No individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Georgia; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Idaho-1; 
Complete benefits wraparound provided[B]: No individuals; 
Partial benefits wraparound provided[C]: All individuals. 

State[A]: Idaho-2; 
Complete benefits wraparound provided[B]: No individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Illinois; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Iowa; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Kansas; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Kentucky; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Louisiana; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Maine[D]; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Massachusetts-1; 
Complete benefits wraparound provided[B]: Some individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Massachusetts-2; 
Complete benefits wraparound provided[B]: No individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Minnesota; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Missouri; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Montana; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Nebraska; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Nevada-1; 
Complete benefits wraparound provided[B]: No individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Nevada-2; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: New Hampshire; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: New Jersey-1; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: New Jersey-2; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: New York; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: North Dakota[D]; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Oklahoma; 
Complete benefits wraparound provided[B]: No individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Oregon-1; 
Complete benefits wraparound provided[B]: No individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Oregon-2; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Pennsylvania; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Rhode Island; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: South Carolina; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: South Dakota; 
Complete benefits wraparound provided[B]: No individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Texas; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Utah-1; 
Complete benefits wraparound provided[B]: No individuals; 
Partial benefits wraparound provided[C]: Some individuals. 

State[A]: Utah-2; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Vermont[E]; 
Complete benefits wraparound provided[B]: Some individuals; 
Partial benefits wraparound provided[C]: Some individuals. 

State[A]: Virginia-1; 
Complete benefits wraparound provided[B]: No individuals; 
Partial benefits wraparound provided[C]: All individuals. 

State[A]: Virginia-2; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Washington; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Wisconsin; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

State[A]: Wyoming; 
Complete benefits wraparound provided[B]: All individuals; 
Partial benefits wraparound provided[C]: No individuals. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, CHIP, or both. We received 
responses from officials representing 45 programs in 37 states; 
officials from 2 states with premium assistance programs, North 
Carolina and West Virginia, did not respond to the survey. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[B] States that offer complete benefits wraparound coverage supplement 
private insurance benefits up to the level an individual would receive 
under direct coverage. 

[C] States that offer partial benefits wraparound coverage supplement 
private insurance benefits, but not to the level an individual would 
receive under direct coverage. For example, states may supplement only 
certain benefits, such as dental care, mental health care, or 
immunizations. 

[D] State also provided benefits wraparound coverage to noneligible 
family members. 

[E] Individuals eligible for the state's Vermont Health Access Program 
and receiving subsidized employer-sponsored insurance (ESI) through 
the premium assistance program received complete benefits wraparound 
coverage. Individuals receiving subsidized ESI but not eligible for 
the Vermont Health Access Plan receive a benefits wraparound coverage 
for prevention and maintenance of specified chronic conditions. 

[End of table] 

Table 13: Monitoring of Enrollees' Access to Care and Utilization of 
Services, by State Premium Assistance Program, 2009: 

State[A]: Alabama; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Alaska; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Arizona; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: California; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Colorado-1; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Colorado-2; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Florida; 
State monitors access to care: Response not provided; 
State monitors utilization of services: Response not provided. 

State[A]: Georgia; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Check]. 

State[A]: Idaho-1; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Idaho-2; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Illinois; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Check]. 

State[A]: Iowa; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Kansas; 
State monitors access to care: [Check]; 
State monitors utilization of services: [Check]. 

State[A]: Kentucky; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Louisiana; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Maine; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Check]. 

State[A]: Massachusetts-1; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Massachusetts-2; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Minnesota; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Missouri; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Montana; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Nebraska; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Nevada-1; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Nevada-2; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: New Hampshire; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Check]. 

State[A]: New Jersey-1; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: New Jersey-2; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: New York; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: North Dakota; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Oklahoma; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Oregon-1; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Oregon-2; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Pennsylvania; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Rhode Island; 
State monitors access to care: [Check]; 
State monitors utilization of services: [Check]. 

State[A]: South Carolina; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Check]. 

State[A]: South Dakota; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Texas; 
State monitors access to care: [Check]; 
State monitors utilization of services: [Check]. 

State[A]: Utah-1; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Utah-2; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Check]. 

State[A]: Vermont; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Virginia-1; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Virginia-2; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Washington; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Wisconsin; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Check]. 

State[A]: Wyoming; 
State monitors access to care: [Empty]; 
State monitors utilization of services: [Empty]. 

State[A]: Total; 
State monitors access to care: 3; 
State monitors utilization of services: 10. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Legend: 

[Check] = State monitors. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, CHIP, or both. We received 
responses from officials representing 45 programs in 37 states; 
officials from 2 states with premium assistance programs, North 
Carolina and West Virginia, did not respond to the survey. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[End of table] 

Table 14: Description of Monthly Premium Subsidy Provided, by State 
Premium Assistance Program, 2009: 

State[A]: Alabama; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: Alaska; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: Arizona; 
Premium subsidy: Up to $100 per eligible child. 

State[A]: California; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: Colorado-1; 
Premium subsidy: Up to $100 per eligible enrollee. 

State[A]: Colorado-2; 
Premium subsidy: Portion of premium that covers eligible enrollee 
(amount policyholder would save if eligible enrollee were not covered). 

State[A]: Florida; 
Premium subsidy: Pays up to amount state would pay if individual were 
in a Medicaid Reform Plan which varies between individuals[B]. 

State[A]: Georgia; 
Premium subsidy: 100 percent of policyholder's share of premium. 

State[A]: Idaho-1; 
Premium subsidy: Up to $100 per enrollee with $300 family cap. 

State[A]: Idaho-2; 
Premium subsidy: Up to $100 per member. 

State[A]: Illinois; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: Iowa; 
Premium subsidy: Response not provided. 

State[A]: Kansas; 
Premium subsidy: 100 percent of enrollee's and policyholder's share of 
premium. 

State[A]: Kentucky; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: Louisiana; 
Premium subsidy: 100 percent of enrollee's share of premium, up to 
$200. 

State[A]: Maine; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: Massachusetts-1; 
Premium subsidy: Portion of enrollee's premium. 

State[A]: Massachusetts-2; 
Premium subsidy: 80 percent of enrollee's share of premium, up to $450 
per individual or $1,110 per family. 

State[A]: Minnesota; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: Missouri; 
Premium subsidy: 100 percent of policyholder's share of premium. 

State[A]: Montana; 
Premium subsidy: 100 percent of enrollee's share of the premium. 

State[A]: Nebraska; 
Premium subsidy: 100 percent of the enrollee's share of premium. 

State[A]: Nevada-1; 
Premium subsidy: 50 percent of employee's coverage cost, up to $100 
per enrollee. 

State[A]: Nevada-2; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: New Hampshire; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: New Jersey-1; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: New Jersey-2; 
Premium subsidy: 100 percent of employee's share of premium. 

State[A]: New York; 
Premium subsidy: 100 percent of employee's share of premium. 

State[A]: North Dakota; 
Premium subsidy: 
* 100 percent of individual/family's share of premium; 
* If an individual has to spend down assets to qualify for Medicaid, 
then the premium subsidy is reduced by that amount. 

State[A]: Oklahoma; 
Premium subsidy: 
* At least 60 percent of the cost of covering the employee and 85 
percent of cost of covering the spouse; 
* Employee's premium contributions are limited to 3 percent of gross 
income. 

State[A]: Oregon-1; 
Premium subsidy: 50 to 95 percent of eligible family member's premium. 

State[A]: Oregon-2; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: Pennsylvania; 
Premium subsidy: Response not provided. 

State[A]: Rhode Island; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: South Carolina; 
Premium subsidy: 
* 100 percent of enrollee's share of premium; 
* If necessary to cover enrollee, program will pay the policyholder's 
share of premium. 

State[A]: South Dakota; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: Texas; 
Premium subsidy: 100 percent of policyholder's share of premium. 

State[A]: Utah-1; 
Premium subsidy: 
* Up to $150 for covered adults; 
* $120 for children whose insurance covers dental services and $100 
for children whose insurance does not cover dental services. 

State[A]: Utah-2; 
Premium subsidy: Up to 100 percent of enrollee's share of premium[C]. 

State[A]: Vermont; 
Premium subsidy: Percentage of enrollee's share of premium based on 
enrollee's income. 

State[A]: Virginia-1; 
Premium subsidy: Up to $100 per month towards enrollee's share of 
premium. 

State[A]: Virginia-2; 
Premium subsidy: The lesser of the cost-effective rate for each 
Medicaid-eligible individual or the employee's share of premium[D]. 

State[A]: Washington; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: Wisconsin; 
Premium subsidy: 100 percent of enrollee's share of premium. 

State[A]: Wyoming; 
Premium subsidy: 100 percent of enrollee's share of premium. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, CHIP, or both. We received 
responses from officials representing 45 programs in 37 states; 
officials from 2 states with premium assistance programs, North 
Carolina and West Virginia, did not respond to the survey. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[B] A Medicaid Reform plan is a managed care health plan--chosen by 
Medicaid-eligible individuals--which provides them with health 
coverage. 

[C] Officials from this premium assistance program indicated that, 
depending on the cost-effectiveness calculation, the state's premium 
subsidy may be negotiated with the enrollee to be an amount less than 
100 percent of the enrollee's share of the premium. 

[D] Officials from this premium assistance program indicated that the 
cost-effective rate was based on several factors including age, 
gender, and region of the state where the eligible individual lived. 

[End of table] 

Table 15: Extent to Which the State Paid for Cost Sharing Expenses 
(Excluding Premiums), by Coverage Group and State Premium Assistance 
Program, 2009: 

State[A]: Alabama[B]; Coverage groups: Children: State pays some cost 
sharing; 
Coverage groups: Pregnant women/unborn children: State pays some cost 
sharing; 
Coverage groups: Parents: State pays some cost sharing; 
Coverage groups: Childless adults: NA; 
Coverage groups: Other individuals: State pays some cost sharing[C]. 

State[A]: Alaska;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: State pays all cost sharing;
Coverage groups: Other individuals: State pays all cost sharing. 

State[A]: Arizona;
Coverage groups: Children: State pays no cost sharing;
Coverage groups: Pregnant women/unborn children: State pays no cost 
sharing;
Coverage groups: Parents: State pays no cost sharing;
Coverage groups: Childless adults: State pays no cost sharing;
Coverage groups: Other individuals: State pays no cost sharing. 

State[A]: California[D];
Coverage groups: Children: State pays some cost sharing;
Coverage groups: Pregnant women/unborn children: State pays some cost 
sharing;
Coverage groups: Parents: State pays some cost sharing;
Coverage groups: Childless adults: State pays some cost sharing;
Coverage groups: Other individuals: State pays some cost sharing. 

State[A]: Colorado-1;
Coverage groups: Children: State pays no cost sharing;
Coverage groups: Pregnant women/unborn children: State pays no cost 
sharing;
Coverage groups: Parents: NA;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: NA. 

State[A]: Colorado-2;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: State pays all cost sharing;
Coverage groups: Other individuals: State pays all cost sharing. 

State[A]: Florida;
Coverage groups: Children: State pays no cost sharing;
Coverage groups: Pregnant women/unborn children: State pays no cost 
sharing;
Coverage groups: Parents: State pays no cost sharing;
Coverage groups: Childless adults: State pays no cost sharing;
Coverage groups: Other individuals: Response not provided. 

State[A]: Georgia;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: State pays all cost sharing;
Coverage groups: Other individuals: Response not provided. 

State[A]: Idaho-1;
Coverage groups: Children: State pays no cost sharing;
Coverage groups: Pregnant women/unborn children: NA;
Coverage groups: Parents: NA;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: NA. 

State[A]: Idaho-2;
Coverage groups: Children: NA;
Coverage groups: Pregnant women/unborn children: State pays no cost 
sharing;
Coverage groups: Parents: State pays no cost sharing;
Coverage groups: Childless adults: State pays no cost sharing;
Coverage groups: Other individuals: NA. 

State[A]: Illinois[B];
Coverage groups: Children: State pays some cost sharing;
Coverage groups: Pregnant women/unborn children: State pays some cost 
sharing;
Coverage groups: Parents: State pays some cost sharing;
Coverage groups: Childless adults: State pays no cost sharing;
Coverage groups: Other individuals: State pays some cost sharing. 

State[A]: Iowa;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: State pays all cost sharing;
Coverage groups: Other individuals: Response not provided. 

State[A]: Kansas;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: State pays all cost sharing;
Coverage groups: Other individuals: State pays all cost sharing. 

State[A]: Kentucky;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: State pays all cost sharing;
Coverage groups: Other individuals: Response not provided. 

State[A]: Louisiana;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: NA. 

State[A]: Maine;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: State pays all cost sharing;
Coverage groups: Other individuals: State pays no cost sharing. 

State[A]: Massachusetts-1;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: State pays no cost sharing;
Coverage groups: Other individuals: State pays no cost sharing. 

State[A]: Massachusetts-2;
Coverage groups: Children: NA;
Coverage groups: Pregnant women/unborn children: NA;
Coverage groups: Parents: NA;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: State pays no cost sharing. 

State[A]: Minnesota;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: State pays all cost sharing[E]. 

State[A]: Missouri[F];
Coverage groups: Children: State pays some cost sharing;
Coverage groups: Pregnant women/unborn children: State pays some cost 
sharing;
Coverage groups: Parents: State pays some cost sharing;
Coverage groups: Childless adults: Response not provided;
Coverage groups: Other individuals: State pays some cost sharing[G]. 

State[A]: Montana;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: State pays all cost sharing;
Coverage groups: Other individuals: Response not provided. 

State[A]: Nebraska;
Coverage groups: Children: State pays some cost sharing;
Coverage groups: Pregnant women/unborn children: State pays some cost 
sharing;
Coverage groups: Parents: State pays some cost sharing;
Coverage groups: Childless adults: State pays some cost sharing;
Coverage groups: Other individuals: NA. 

State[A]: Nevada-1;
Coverage groups: Children: State pays no cost sharing;
Coverage groups: Pregnant women/unborn children: NA;
Coverage groups: Parents: State pays no cost sharing;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: State pays no cost sharing. 

State[A]: Nevada-2;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: State pays all cost sharing;
Coverage groups: Other individuals: Response not provided. 

State[A]: New Hampshire[B];
Coverage groups: Children: State pays some cost sharing;
Coverage groups: Pregnant women/unborn children: State pays some cost 
sharing;
Coverage groups: Parents: NA;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: State pays some cost sharing[H]. 

State[A]: New Jersey-1[F];
Coverage groups: Children: State pays some cost sharing;
Coverage groups: Pregnant women/unborn children: NA;
Coverage groups: Parents: State pays some cost sharing;
Coverage groups: Childless adults: State pays some cost sharing;
Coverage groups: Other individuals: Response not provided. 

State[A]: New Jersey-2;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: NA;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: Response not provided. 

State[A]: New York;
Coverage groups: Children: NA;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: State pays all cost sharing;
Coverage groups: Other individuals: Response not provided. 

State[A]: North Dakota;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: State pays all cost sharing[I]. 

State[A]: Oklahoma[J];
Coverage groups: Children: NA;
Coverage groups: Pregnant women/unborn children: State pays some cost 
sharing;
Coverage groups: Parents: State pays some cost sharing;
Coverage groups: Childless adults: State pays some cost sharing;
Coverage groups: Other individuals: Response not provided. 

State[A]: Oregon-1;
Coverage groups: Children: State pays no cost sharing;
Coverage groups: Pregnant women/unborn children: State pays no cost 
sharing;
Coverage groups: Parents: State pays no cost sharing;
Coverage groups: Childless adults: State pays no cost sharing;
Coverage groups: Other individuals: NA. 

State[A]: Oregon-2[F];
Coverage groups: Children: State pays some cost sharing;
Coverage groups: Pregnant women/unborn children: State pays some cost 
sharing;
Coverage groups: Parents: State pays some cost sharing;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: Response not provided. 

State[A]: Pennsylvania;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: State pays all cost sharing;
Coverage groups: Other individuals: State pays all cost sharing. 

State[A]: Rhode Island;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: Response not provided. 

State[A]: South Carolina;
Coverage groups: Children: State pays some cost sharing;
Coverage groups: Pregnant women/unborn children: State pays some cost 
sharing;
Coverage groups: Parents: State pays some cost sharing;
Coverage groups: Childless adults: State pays some cost sharing;
Coverage groups: Other individuals: Response not provided. 

State[A]: South Dakota;
Coverage groups: Children: State pays no cost sharing;
Coverage groups: Pregnant women/unborn children: State pays no cost 
sharing;
Coverage groups: Parents: State pays no cost sharing;
Coverage groups: Childless adults: State pays no cost sharing;
Coverage groups: Other individuals: State pays no cost sharing. 

State[A]: Texas;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: NA. 

State[A]: Utah-1;
Coverage groups: Children: State pays no cost sharing;
Coverage groups: Pregnant women/unborn children: NA;
Coverage groups: Parents: State pays no cost sharing;
Coverage groups: Childless adults: State pays no cost sharing;
Coverage groups: Other individuals: NA. 

State[A]: Utah-2;
Coverage groups: Children: State pays some cost sharing;
Coverage groups: Pregnant women/unborn children: State pays some cost 
sharing;
Coverage groups: Parents: State pays some cost sharing;
Coverage groups: Childless adults: State pays some cost sharing;
Coverage groups: Other individuals: Response not provided. 

State[A]: Vermont;
Coverage groups: Children: NA;
Coverage groups: Pregnant women/unborn children: NA;
Coverage groups: Parents: State pays some cost sharing[K];
Coverage groups: Childless adults: State pays some cost sharing[K];
Coverage groups: Other individuals: Response not provided. 

State[A]: Virginia-1;
Coverage groups: Children: State pays no cost sharing;
Coverage groups: Pregnant women/unborn children: NA;
Coverage groups: Parents: NA;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: NA. 

State[A]: Virginia-2;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: NA. 

State[A]: Washington;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: State pays all cost sharing;
Coverage groups: Other individuals: Response not provided. 

State[A]: Wisconsin;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: State pays all cost sharing;
Coverage groups: Other individuals: NA. 

State[A]: Wyoming;
Coverage groups: Children: State pays all cost sharing;
Coverage groups: Pregnant women/unborn children: State pays all cost 
sharing;
Coverage groups: Parents: State pays all cost sharing;
Coverage groups: Childless adults: NA;
Coverage groups: Other individuals: NA. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

NA = Not applicable, the coverage group is not eligible for the 
premium assistance program. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, CHIP, or both. We received 
responses from officials representing 45 programs in 37 states; 
officials from 2 states with premium assistance programs, North 
Carolina and West Virginia, did not respond to the survey. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[B] Officials representing these programs indicated that the state 
paid cost sharing up to the Medicaid allowed payment for a particular 
service if the enrollee received that service from a Medicaid 
participating provider. The officials noted that if the enrollee sees 
a provider that does not participate in Medicaid, the state did not 
pay cost sharing. 

[C] This program paid some cost sharing for individuals eligible for 
Supplemental Security Income program. 

[D] Officials representing this program indicated that the state paid 
cost sharing up to the Medicaid allowed payment for a particular 
service if the enrollee received that service from a Medicaid 
participating provider. The officials noted that if the enrollee sees 
a provider that does not participate in Medicaid, the state did not 
pay cost sharing. Additionally, if the enrollee were required to spend 
down income to qualify for Medicaid, then the state did not pay for 
cost sharing until the enrollee contributed his or her spend-down 
amount. 

[E] Officials representing this program indicated that the state paid 
cost sharing for elderly and disabled individuals. 

[F] Officials representing these programs indicated that the state 
paid cost sharing for Medicaid covered services only. 

[G] Officials representing this program indicated that the state paid 
some cost sharing for individuals who are aged, blind, or permanently 
disabled. 

[H] Officials representing this program indicated that the state paid 
cost sharing for individuals who are blind, disabled, or in foster 
care. 

[I] Officials representing this program indicated that the state paid 
some cost sharing for individuals who are aged or disabled. 

[J] Officials representing this program indicated that the state paid 
up to $900 for cost sharing if the household's out-of-pocket expenses 
had exceeded 5 percent of their gross income. 

[K] Officials representing this program indicated that the state paid 
all cost sharing for parents with incomes below 185 percent of the 
federal poverty level (FPL) and childless adults with incomes below 
150 percent of the FPL. 

[End of table] 

[End of Enclosure III] 

Enclosure IV: States' Premium Assistance Programs' Expenditures and 
Cost-Effectiveness Policies: 

Table 16: Program Expenditures, by Type of Expenditure and State 
Premium Assistance Program, July 1, 2008 through June 30, 2009: 

State[A]: Alabama; 
Premium subsidies: 17,051; 
Benefits wraparound: 31,176; 
Cost sharing: 0; 
Administration: 0; 
Total: 48,227[B]. 

State[A]: Alaska; 
Premium subsidies: 34,498; 
Benefits wraparound: Response not provided; 
Cost sharing: Response not provided; 
Administration: Response not provided; 
Total: 34,498[B]. 

State[A]: Arizona; 
Premium subsidies: 900; 
Benefits wraparound: NA; 
Cost sharing: NA; 
Administration: 0; 
Total: 900[B]. 

State[A]: California; 
Premium subsidies: 5,845,615; 
Benefits wraparound: [C]; 
Cost sharing: [C]; 
Administration: 590,606; 
Total: 6,436,221[B]. 

State[A]: Colorado-1; 
Premium subsidies: 63,018; 
Benefits wraparound: NA; 
Cost sharing: NA; 
Administration: Response not provided; 
Total: 63,018[B]. 

State[A]: Colorado-2; 
Premium subsidies: 935,864; 
Benefits wraparound: [C]; 
Cost sharing: 7,246; 
Administration: [C]; 
Total: 943,110[B]. 

State[A]: Florida; 
Premium subsidies: 10,023; 
Benefits wraparound: NA; 
Cost sharing: NA; 
Administration: 23,400; 
Total: 33,423. 

State[A]: Georgia; 
Premium subsidies: 2,915,713; 
Benefits wraparound: Response not provided; 
Cost sharing: Response not provided; 
Administration: Response not provided; 
Total: 2,915,713[B]. 

State[A]: Idaho-1; 
Premium subsidies: 130,258; 
Benefits wraparound: 0; 
Cost sharing: NA; 
Administration: 18,795; 
Total: 149,053[B]. 

State[A]: Idaho-2; 
Premium subsidies: 305,151; 
Benefits wraparound: NA; 
Cost sharing: NA; 
Administration: 41,348; 
Total: 346,499. 

State[A]: Illinois; 
Premium subsidies: 391,744; 
Benefits wraparound: [C]; 
Cost sharing: 0; 
Administration: [C]; 
Total: 391,744[B]. 

State[A]: Iowa; 
Premium subsidies: 6,498,885; 
Benefits wraparound: [C]; 
Cost sharing: [C]; 
Administration: 1,140,909; 
Total: 7,639,794[B]. 

State[A]: Kansas; 
Premium subsidies: [C]; 
Benefits wraparound: [C]; 
Cost sharing: [C]; 
Administration: [C]; 
Total: 736,763[B]. 

State[A]: Kentucky; 
Premium subsidies: 1,073; 
Benefits wraparound: [C]; 
Cost sharing: [C]; 
Administration: [C]; 
Total: 1,073[B]. 

State[A]: Louisiana; 
Premium subsidies: 2,037,783; 
Benefits wraparound: 5,553,673; 
Cost sharing: 0; 
Administration: 382,875; 
Total: 7,974,331. 

State[A]: Maine; 
Premium subsidies: 885,834; 
Benefits wraparound: [C]; 
Cost sharing: [C]; 
Administration: 410,000; 
Total: 1,295,834[B]. 

State[A]: Massachusetts-1; 
Premium subsidies: 49,000,000; 
Benefits wraparound: [C]; 
Cost sharing: [C]; 
Administration: [C]; 
Total: 49,000,000[B]. 

State[A]: Massachusetts-2; 
Premium subsidies: 19,792,990; 
Benefits wraparound: NA; 
Cost sharing: NA; 
Administration: 737,046; 
Total: 20,530,036. 

State[A]: Minnesota; 
Premium subsidies: 14,712,740; 
Benefits wraparound: [C]; 
Cost sharing: Response not provided; 
Administration: [C]; 
Total: 14,712,740[B]. 

State[A]: Missouri; 
Premium subsidies: 3,495,089; 
Benefits wraparound: [C]; 
Cost sharing: 30,179; 
Administration: [C]; 
Total: 3,525,268[B]. 

State[A]: Montana; 
Premium subsidies: 990,551; 
Benefits wraparound: [C]; 
Cost sharing: [C]; 
Administration: 44,935; 
Total: 1,035,486[B]. 

State[A]: Nebraska; 
Premium subsidies: 1,035,560; 
Benefits wraparound: NA; 
Cost sharing: [C]; 
Administration: 62,501; 
Total: 1,098,061[B]. 

State[A]: Nevada-1; 
Premium subsidies: 3,574; 
Benefits wraparound: NA; 
Cost sharing: NA; 
Administration: 39,388; 
Total: 42,962. 

State[A]: Nevada-2; 
Premium subsidies: 173,940; 
Benefits wraparound: 407,931; 
Cost sharing: Response not provided; 
Administration: Response not provided; 
Total: 591,219[B,D]. 

State[A]: New Hampshire; 
Premium subsidies: 911,581; 
Benefits wraparound: 0; 
Cost sharing: 0; 
Administration: 82,686; 
Total: 994,267[B]. 

State[A]: New Jersey-1; 
Premium subsidies: 584,943; 
Benefits wraparound: [C]; 
Cost sharing: 16,638; 
Administration: [C]; 
Total: 601,581[B]. 

State[A]: New Jersey-2; 
Premium subsidies: 206,980; 
Benefits wraparound: [C]; 
Cost sharing: 32,408; 
Administration: [C]; 
Total: 239,388[B]. 

State[A]: New York; 
Premium subsidies: [C]; 
Benefits wraparound: [C]; 
Cost sharing: [C]; 
Administration: [C]; 
Total: [C]. 

State[A]: North Dakota; 
Premium subsidies: 140,590; 
Benefits wraparound: [C]; 
Cost sharing: [C]; 
Administration: [C]; 
Total: 140,590[B]. 

State[A]: Oklahoma; 
Premium subsidies: [C]; 
Benefits wraparound: NA; 
Cost sharing: [C]; 
Administration: [C]; 
Total: [C]. 

State[A]: Oregon-1; 
Premium subsidies: 20,792,412; 
Benefits wraparound: NA; 
Cost sharing: NA; 
Administration: 3,824,058; 
Total: 24,616,470. 

State[A]: Oregon-2; 
Premium subsidies: 724,360; 
Benefits wraparound: [C]; 
Cost sharing: [C]; 
Administration: [C]; 
Total: 724,360[B]. 

State[A]: Pennsylvania; 
Premium subsidies: Response not provided; 
Benefits wraparound: Response not provided; 
Cost sharing: Response not provided; 
Administration: Response not provided; 
Total: Response not provided. 

State[A]: Rhode Island; 
Premium subsidies: 8,174,977; 
Benefits wraparound: 1,793,526; 
Cost sharing: Response not provided; 
Administration: c; 
Total: 9,968,503[B]. 

State[A]: South Carolina; 
Premium subsidies: 493,659; 
Benefits wraparound: [C]; 
Cost sharing: [C]; 
Administration: 119,042; 
Total: 612,701[B]. 

State[A]: South Dakota; 
Premium subsidies: 268,568; 
Benefits wraparound: NA; 
Cost sharing: NA; 
Administration: 50,000; 
Total: 318,568. 

State[A]: Texas; 
Premium subsidies: 17,478,158; 
Benefits wraparound: 4,330,790; 
Cost sharing: [C]; 
Administration: 917,042; 
Total: 22,725,990[B]. 

State[A]: Utah-1; 
Premium subsidies: 609,042; 
Benefits wraparound: 19,200; 
Cost sharing: NA; 
Administration: 64,235; 
Total: 823,155[E]. 

State[A]: Utah-2; 
Premium subsidies: Response not provided; 
Benefits wraparound: [C]; 
Cost sharing: [C]; 
Administration: [C]; 
Total: 520,000[B]. 

State[A]: Vermont; 
Premium subsidies: 23,697,720; 
Benefits wraparound: 454,787; 
Cost sharing: Response not provided; 
Administration: 1,278,217; 
Total: 25,430,724. 

State[A]: Virginia-1; 
Premium subsidies: 448,288; 
Benefits wraparound: 1,034; 
Cost sharing: NA; 
Administration: 83,617; 
Total: 532,939. 

State[A]: Virginia-2; 
Premium subsidies: 4,968,135; 
Benefits wraparound: [C]; 
Cost sharing: [C]; 
Administration: 342,367; 
Total: 5,365,702[B,F]. 

State[A]: Washington; 
Premium subsidies: 6,738,384; 
Benefits wraparound: Response not provided; 
Cost sharing: Response not provided; 
Administration: 1,040,267; 
Total: 7,778,651[B]. 

State[A]: Wisconsin; 
Premium subsidies: 915,495; 
Benefits wraparound: 764,977; 
Cost sharing: [C]; 
Administration: [C]; 
Total: 1,680,472[B]. 

State[A]: Wyoming; 
Premium subsidies: 50,758; 
Benefits wraparound: Response not provided; 
Cost sharing: Response not provided; 
Administration: Response not provided; 
Total: 50,758[B]. 

State[A]: Total; 
Premium subsidies: 196,481,904; 
Benefits wraparound: 13,357,094; 
Cost sharing: 86,471; 
Administration: 11,293,334; 
Total: 222,670,792[G]. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

NA = Not applicable; the premium assistance program did not pay for 
this item. 

Notes: Data were obtained from surveys administered from August 
through October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, State Children's Health 
Insurance Program (CHIP), or both. We received responses from 
officials representing 45 programs in 37 states; officials from 2 
states with premium assistance programs, North Carolina and West 
Virginia, did not respond to the survey. 

Amounts shown are combined federal and state expenditures. 

Data on program expenditures were generally for the period of July 1, 
2008, through June 30, 2009. However, the following programs provided 
data for a different period: Idaho-1 and Idaho-2 - October 1, 2007, 
through September 30, 2008; Rhode Island and Wisconsin - July 1, 2007, 
through June 30, 2008; Texas - September 1, 2008, through August 31, 
2009; Virginia-2 - 2007 for data on program administration and other 
expenditures, including Medicaid Management Information System 
enhancements. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[B] This figure is the total of all reported expenditures. However, 
actual total expenditures for the program are likely higher because 
the program did not provide data for all applicable types of 
expenditures. 

[C] Program officials reported that data were not available. 

[D] This figure includes $9,349 in other reported expenditures. 

[E] This figure includes $130,678 in other reported expenditures. 

[F] This figure includes $55,200 in other reported expenditures. 

[G] This figure includes $195,227 in other reported expenditures, as 
well as $736,763 in total expenditures reported for the Kansas program 
and $520,000 in total expenditures reported for the Utah-2 program. 
Additionally, this figure is the total of all reported expenditures. 
However, actual total expenditures for the programs are likely higher 
because some programs did not provide data for all applicable types of 
expenditures. 

[End of table] 

Table 17: Cost-effectiveness Requirements and Methods Used, by State 
Premium Assistance Program, 2009: 

State[A]: Alabama; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Alaska; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Arizona; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: California; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Colorado-1; 
Cost-effectiveness requirement: [Empty]; 
Level at which cost-effectiveness is assessed: Individual/family: NA; 
Level at which cost-effectiveness is assessed: Aggregate: NA; 
[Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: NA; 
Method used to calculate cost-effectiveness: Other method[C]: NA. 

State[A]: Colorado-2; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Florida; 
Cost-effectiveness requirement: [Empty]; 
Level at which cost-effectiveness is assessed: Individual/family: NA; 
Level at which cost-effectiveness is assessed: Aggregate: NA; 
Method used to calculate cost-effectiveness: Secretary's method[B]: NA; 
Method used to calculate cost-effectiveness: Other method[C]: NA. 

State[A]: Georgia; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Idaho-1; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Empty]; 
Level at which cost-effectiveness is assessed: Aggregate: [Check]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Idaho-2; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Empty]; 
Level at which cost-effectiveness is assessed: Aggregate: [Check]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Illinois; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Iowa; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Kansas; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Kentucky; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Louisiana; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Maine; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
[Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Massachusetts-1; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Massachusetts-2; 
Cost-effectiveness requirement: [Empty]; 
Level at which cost-effectiveness is assessed: Individual/family: NA; 
Level at which cost-effectiveness is assessed: Aggregate: NA; 
Method used to calculate cost-effectiveness: Secretary's method[B]: NA; 
Method used to calculate cost-effectiveness: Other method[C]: NA. 

State[A]: Minnesota; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Missouri; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Montana; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Nebraska; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Nevada-1; 
Cost-effectiveness requirement: [Empty]; 
Level at which cost-effectiveness is assessed: Individual/family: NA; 
Level at which cost-effectiveness is assessed: Aggregate: NA; 
Method used to calculate cost-effectiveness: Secretary's method[B]: NA; 
Method used to calculate cost-effectiveness: Other method[C]: NA. 

State[A]: Nevada-2; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 

Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: New Hampshire; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: New Jersey-1; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: New Jersey-2; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
[Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: New York; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Empty]; 
Level at which cost-effectiveness is assessed: Aggregate: [Check]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: North Dakota; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
[Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Oklahoma; 
Cost-effectiveness requirement: [Empty]; 
Level at which cost-effectiveness is assessed: Individual/family: NA; 
Level at which cost-effectiveness is assessed: Aggregate: NA; 
Method used to calculate cost-effectiveness: Secretary's method[B]: NA; 
Method used to calculate cost-effectiveness: Other method[C]: NA. 

State[A]: Oregon-1; 
Cost-effectiveness requirement: [Empty]; 
Level at which cost-effectiveness is assessed: Individual/family: NA; 
Level at which cost-effectiveness is assessed: Aggregate: NA; 
[Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: NA; 
Method used to calculate cost-effectiveness: Other method[C]: NA. 

State[A]: Oregon-2; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Pennsylvania; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Rhode Island; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Empty]; 
Level at which cost-effectiveness is assessed: Aggregate: [Check]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: South Carolina; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
[Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: South Dakota; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Texas; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Utah-1; 
Cost-effectiveness requirement: [Empty]; 
Level at which cost-effectiveness is assessed: Individual/family: NA; 
Level at which cost-effectiveness is assessed: Aggregate: NA; 
[Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: NA; 
Method used to calculate cost-effectiveness: Other method[C]: NA. 

State[A]: Utah-2; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Empty]; 
Level at which cost-effectiveness is assessed: Aggregate: [Check]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Vermont; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Virginia-1; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Empty]; 
Level at which cost-effectiveness is assessed: Aggregate: [Check]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Virginia-2; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Washington; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Wisconsin; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Empty]; 
Method used to calculate cost-effectiveness: Other method[C]: [Check]. 

State[A]: Wyoming; 
Cost-effectiveness requirement: [Check]; 
Level at which cost-effectiveness is assessed: Individual/family: 
[Check]; 
Level at which cost-effectiveness is assessed: Aggregate: [Empty]; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 
[Check]; 
Method used to calculate cost-effectiveness: Other method[C]: [Empty]. 

State[A]: Total; 
Cost-effectiveness requirement: 38; 
Level at which cost-effectiveness is assessed: Individual/family: 32; 
Level at which cost-effectiveness is assessed: Aggregate: 6; 
Method used to calculate cost-effectiveness: Secretary's method[B]: 18; 
Method used to calculate cost-effectiveness: Other method[C]: 20. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Legend: 

[Check] = Requirement or method used. 

NA = Not applicable, the program does not have a cost-effectiveness 
requirement. 

Note: Data were obtained from surveys administered from August through 
October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, CHIP, or both. We received 
responses from officials representing 45 programs in 37 states; 
officials from 2 states with premium assistance programs, North 
Carolina and West Virginia, did not respond to the survey. 

[A] Some states operated two premium assistance programs. For program 
names, see table 2. 

[B] Section 3910 of the State Medicaid Manual states that an 
individual's enrollment in premium assistance is cost-effective if the 
amount paid for premiums, coinsurance, deductibles, other cost 
sharing, as well as administrative costs, is likely to be less than 
the Medicaid expenditures for an equivalent set of services. To 
determine whether premium assistance is cost-effective, section 3910 
of the State Medicaid Manual offers a calculation states can use. This 
calculation--referred to as the Secretary's method--involves a seven-
step process that takes into account information on the group health 
plan; average Medicaid costs; Medicaid cost for services included in 
the group health plan; the group health plan cost for included 
services; an adjustment for coinsurance and deductible amounts; and 
additional administrative costs for processing the group health plan 
information. 

[C] Respondents who indicated "other method" used a method designed by 
the state and approved by the Centers for Medicare & Medicaid Services. 

[End of table] 

[End of Enclosure IV] 

Enclosure V: Challenges to States' Premium Assistance Programs' 
Implementation and Operation: 

Table 18: Challenges to Premium Assistance Program Implementation or 
Operation, 2009: 

Factor: Limited number of individuals with access to private health 
insurance; 
Number of programs where officials indicated that factor posed a 
challenge: 18. 

Factor: Difficulty identifying individuals with access to private 
health insurance; 
Number of programs where officials indicated that factor posed a 
challenge: 17. 

Factor: Difficulty enrolling individuals due to limits in the 
enrollment periods for the private health insurance; 
Number of programs where officials indicated that factor posed a 
challenge: 16. 

Factor: Difficulty getting necessary information from health plans or 
employers; 
Number of programs where officials indicated that factor posed a 
challenge: 16. 

Factor: Limited participation due to voluntary enrollment; 
Number of programs where officials indicated that factor posed a 
challenge: 16. 

Factor: Difficulty meeting cost-effectiveness standards; 
Number of programs where officials indicated that factor posed a 
challenge: 13. 

Factor: Program administrative costs too high; 
Number of programs where officials indicated that factor posed a 
challenge: 6. 

Factor: Available private health plans often do not meet the minimum 
benefit requirements; 
Number of programs where officials indicated that factor posed a 
challenge: 4. 

Factor: Challenges providing benefits wraparound coverage; 
Number of programs where officials indicated that factor posed a 
challenge: 3. 

Factor: State fiscal challenges and other budget constraints; 
Number of programs where officials indicated that factor posed a 
challenge: 3. 

Source: GAO Web-based survey administered to states' premium 
assistance programs. 

Notes: Data were obtained from surveys administered from August 
through October 2009 to officials in 39 states representing 47 premium 
assistance programs funded by Medicaid, State Children's Health 
Insurance Program (CHIP), or both. We received responses from 
officials representing 45 programs in 37 states; officials from 2 
states with premium assistance programs, North Carolina and West 
Virginia, did not respond to the survey. 

Responses from program officials (representing 45 premium assistance 
programs) were included in this table if they indicated that the 
factor posed either a great or moderate challenge to program 
implementation or operation. 

[End of table] 

[End of Enclosure V] 

Enclosure VI: Agency Comment Letter: 

Department Of Health & Human Services: 
Office Of The Secretary: 
Assistant Secretary for Legislation: 
Washington, DC 20201: 

December 18, 2009: 

Carolyn Yocom: 
Acting Director, Health Care: 
U.S. Government Accountability Office: 
441 G Street N.W. 
Washington, DC 20548: 

Dear Ms. Yocom: 

Enclosed are comments on the U.S. Government Accountability Office's 
(GAO) report entitled: Medicaid and CHIP: Enrollment, Benefits, 
Expenditures, and Other Characteristics of State Premium Assistance 
Programs (GAO-10-258R). 

The Department appreciates the opportunity to review this report 
before its publication. 

Sincerely, 

Andrea Palm; 
Acting Assistant Secretary for Legislation: 

Enclosure: 

Department Of Health & Human Services: 
Center for Medicare and Medicaid Services: 
Administrator: 
Washington, DC 20201: 

Date: December 17 2009: 

To: Andrea Palm: 
Acting Assistant Secretary for Legislation: 
Office of the Secretary: 

From: [Signed by] Charlene Frizzera: 
Acting Administrator: 

Subject: Government Accountability Office (GAO) Draft Report: 
"Medicaid and CHIP: Enrollment, Benefits, Expenditures, and Other 
Characteristics of State Premium Assistance Programs" (GAO-10-258R): 

The Centers for Medicare & Medicaid Services (CMS) appreciates the 
opportunity to review and comment on the subject GAO Draft Report. The 
Children's Health Insurance Program Reauthorization Act (CHIPRA) 
required the GAO to study cost and coverage issues related to State 
premium assistance programs receiving Medicaid and Children's Health 
Insurance Program (CHIP) funds. In this draft report, the GAO 
describes States' premium assistance programs, including the--(1) 
funding source, operating authority, and type of private health 
insurance coverage subsidized; (2) policies regarding eligibility and 
enrollment; (3) benefits, premiums, and cost sharing; (4) expenditures 
and cost effectiveness policies; and (5) challenges program officials 
reported in implementing and operating such programs, as well as the 
effect that CHIPRA may have on these challenges. 

From August through October 2009, the GAO administered a web-based 
survey to officials from the States that had premium assistance 
programs funded by Medicaid, CHIP, or both. The GAO identified 47 
premium assistance programs in 39 States. The survey addressed all of 
the dimensions identified above. Of the 47 Medicaid or CHIP funded 
premium assistance programs identified, GAO received survey responses 
from officials representing 45 programs in 37 States, although not 
every official in the 37 States responded to each question. The GAO 
did not include any recommendations for CMS in this report.
Key findings from the report include, but are not limited to: 

* Thirty premium assistance programs were funded solely by Medicaid, 
six programs were funded solely by CHIP, and nine programs were funded 
by both Medicaid and CHIP; 

* Most premium assistance programs operated under the authority of 
section 1906 of the Social Security Act (the Act) (29), while 16 
programs operated under section 1115 waivers, 1 program operated under 
section 2105(c)(3) of the Act, and 10 programs operated under other 
authorities; 

* Reported premium assistance program enrollment ranged from fewer 
than 10 individuals in five programs to more than 10,000 individuals 
in four programs — including one program with more than 36,600 
individuals. Over half of the programs (25) had fewer than 1,000 
enrollees; 

* Forty-three programs subsidized coverage for employer-sponsored 
insurance (ESI), 32 subsidized for Consolidated Omnibus Budget 
Reconciliation Act (COBRA) coverage, and 17 subsidized other group 
health coverage; 

* Twenty-one of the 45 premium assistance programs subsidized non-
group coverage, namely policies purchased from the individual market; 

* Fewer than half of the premium assistance programs (20) mandated 
enrollment for any eligible individuals. Of those, 19 required all 
eligible individuals to enroll, while the remaining program required 
only certain individuals to enroll; 

* Thirty premium assistance programs provided complete benefits 
wraparound to some or all eligible individuals. Of the remaining 15 
programs, four programs provided partial benefits wraparound, 10 
programs provided no benefits wraparound coverage, and one program did 
not indicate whether or not benefits wraparound coverage was provided; 

* Thirty-eight programs required premium assistance to be cost-
effective, meaning that the cost for Medicaid or CHIP to provide 
premium assistance is likely less than the cost to provide direct 
coverage. Of the 38, 32 assessed cost-effectiveness on an individual 
or family level, while the remaining six assessed cost-effectiveness 
on an aggregate level. To calculate the cost-effectiveness, 18 of the 
38 programs reported using the method outlined in the State Medicaid 
Manual and 20 used another method; 

* Officials from 34 premium assistance programs reported that they did 
not monitor access to care or utilization of services for individuals 
enrolled in the premium assistance program. Of the remaining 11 
programs seven programs monitored utilization of services, three 
programs monitored both utilization of services and access to care, 
and one program did not report whether it conducted either type of 
monitoring; 

* The two most common challenges identified by program officials who 
responded to the survey were a limited number of individuals with 
access to private health insurance (18 programs) and difficulty 
identifying individuals with access to private insurance (17 
programs); and; 

* Officials from nine of 13 programs specifically noted that the 
CHIPRA provision making eligibility in premium assistance a qualifying 
event would make it easier to enroll individuals in the premium 
assistance program; 

CMS Response: 

We commend the GAO for its data collection efforts in examining the 
various dimensions of how Medicaid and CHIP premium assistance 
programs operate under title XIX and title XXI of the Act, and believe 
these data will prove useful in serving as a baseline to inform 
Congress and others stakeholders in this subject area. 

We appreciate the fact that the report identifies that the GAO 
utilized a web-based survey administered to States' premium assistance 
program officials as the primary source of State-specific premium 
assistance information however, we request that the GAO clarify in the 
beginning of the report that while CMS did due diligence to verify the 
accuracy of the information in the report, when possible, we were not 
able to verify all of the data. We want to make clear that CMS is 
unable to verify the majority of the State-reported information for a
variety of reasons, including the lack of specificity of whether the 
data relate to the title XIX or title XXI component, the inclusion of 
information (e.g., break out by type of employer sponsored coverage) 
in the report that is not currently collected at the Federal level, 
and the lack of CMS access to the detailed source information. GAO has 
also indicated previously that it does not expect CMS to verify the 
State-reported data. 

We have provided some technical comments that we hope will be helpful 
in refining your draft. CMS appreciates the opportunity to comment on 
this draft report and we look forward to working with the GAO on this 
and other issues. 

[End of Enclosure VI] 

Enclosure VII: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Carolyn L. Yocom, (202) 512-7114 or yocomc@gao.gov: 

Acknowledgments: 

In addition to the contact named above, Michelle Rosenberg, Assistant 
Director; Christie Enders; Nancy Fasciano; Martha R. W. Kelly; Drew 
Long; Kevin Milne; Dan Ries; Lillian Shields; Malissa G. Winograd; and 
Suzanne Worth made key contributions to this report. 

[End of Enclosure VII] 

Footnotes: 

[1] Medicaid and CHIP are joint federal-state programs that finance 
health insurance coverage for certain categories of low-income adults 
and children. 

[2] See J. Alker, Choosing Premium Assistance: What Does State 
Experience Tell Us? (Washington, D.C.: Henry J. Kaiser Family 
Foundation, Kaiser Commission on Medicaid and the Uninsured, May 
2008); D. Belnap and S. Schwartz, Premium Assistance, Pub. No. 2007-
109 (Portland, Maine: National Academy for State Health Policy, 
October 2007); M. Herman, Premium Assistance Programs: Potential Help 
for the Uninsured? (Washington, D.C.: Forum for State Health Policy 
Leadership, National Conference of State Legislatures, 2004); C. Shirk 
and J Ryan, Premium Assistance in Medicaid and SCHIP: Ace in the Hole 
or House of Cards? Issue Brief no. 812 (Washington, D.C.: National 
Health Policy Forum, The George Washington University, July 2006); and 
C. Williams, A Snapshot of State Experience Implementing Premium 
Assistance Programs (Portland, Maine: National Academy for State 
Health Policy, April 2003). 

[3] See Children's Health Insurance Program Reauthorization Act of 
2009, Pub. L. No. 111-3, § 301(c), 123 Stat. 8, 11-15, 57-63. 

[4] Our review of premium assistance programs did not include Medicaid 
or CHIP-funded programs in which the states only subsidize premiums 
for insurance packages they created, as opposed to private health 
insurance packages created by employers or insurance companies. At 
least three states--Arkansas, Massachusetts, and New Mexico--have such 
programs. 

[5] Officials from 11 states and the District of Columbia reported not 
having a Medicaid-or CHIP-funded premium assistance program. An 
official representing 1 of those states reported having a premium 
assistance program in the past that was discontinued, and an official 
representing another state reported plans for implementing a program 
in the future. 

[6] In states with more than one Medicaid-or CHIP-funded premium 
assistance program, officials were asked to complete a separate survey 
for each program. 

[7] We did not receive completed surveys from North Carolina or West 
Virginia and thus were unable to include information about these two 
states' premium assistance programs. 

[8] Section 1906 of the SSA was enacted in the Omnibus Budget 
Reconciliation Act of 1990 and amended in the Balanced Budget Act of 
1997. See Pub. L. No. 101-508, title IV, §4402(a)(2), 104 Stat. 1388- 
161, as amended by Pub. L. No. 105-33, title IV, §4741(b), 111 Stat. 
523. 

[9] Other, less frequently used authorities through which states can 
operate Medicaid-funded premium assistance programs are provided in 
sections 1902 and 1905 of the SSA. Section 1902(a)(10)(F) of the SSA 
allows states to use Medicaid funds to pay premiums for COBRA 
continuation coverage for certain low-income individuals who are not 
currently eligible for Medicaid but who are likely to become Medicaid 
eligible in the future and have high health care costs. COBRA, an 
acronym for the Consolidated Omnibus Budget Reconciliation Act of 
1985, included provisions giving employees the opportunity to remain 
in their employer's group coverage when they would otherwise lose 
coverage. Section 1905(a) of the SSA allows states to use Medicaid 
funds to subsidize premiums for group or nongroup health coverage. In 
this report, we define nongroup health coverage as coverage purchased 
from the individual market. 

[10] States with CHIP Medicaid expansion programs can operate CHIP- 
funded premium assistance programs through Medicaid authorities, such 
as section 1906 of the SSA. States may use one of three basic options 
for structuring their CHIP programs: (1) a Medicaid expansion program, 
(2) a separate child health program, or (3) a combination program that 
includes both a Medicaid expansion and a separate child health 
program. States operating CHIP Medicaid expansion programs must follow 
Medicaid rules, while states operating separate child health programs 
follow CHIP rules. Section 2105(c)(3) of the SSA permits payment to a 
state for family coverage under a group health plan or health 
insurance coverage. Regulations at 42 C.F.R. §457.1010 implement the 
provisions of the statute related to family coverage. 42 C.F.R § 
457.10 implements requirements related to premium assistance programs 
in connection with group health plan coverage. For this report, we 
consider programs operated under either authority to be premium 
assistance programs. 

[11] Through a waiver under section 1115 of the SSA, the Secretary of 
HHS could, for example, allow states to provide services or cover 
individuals not normally eligible for Medicaid and CHIP and provide 
federal funds for costs not otherwise eligible for payment. 

[12] See Pub. L. No. 111-3, § 301, 123 Stat. at 57-63. While CHIPRA 
provided additional options for states to operate premium assistance 
programs, no state had implemented a program under these new options 
as of November 2009. 

[13] The "parents" coverage group includes legal guardians, and the 
"pregnant women" coverage group includes unborn children. Under CHIP, 
states may choose to extend eligibility to unborn children and provide 
prenatal care and delivery. See 67 Fed. Reg. 61956 (Oct. 2, 2002). 

[14] The "other" coverage groups most commonly reported were certain 
unemployed individuals, aged or disabled individuals, or individuals 
receiving Supplemental Security Income benefits. 

[15] Certain exceptions may apply. For example, states that operate 
their premium assistance programs under the authority of section 1906 
of the SSA cannot deny direct coverage to eligible children if their 
parent fails to enroll them in a group health plan. 

[16] Two programs also provided at least some benefits wraparound 
coverage to noneligible family members. 

[17] In programs that provide partial benefits wraparound coverage, 
the state supplements private health insurance benefits, but not to 
the level an individual would receive under direct coverage. For 
example, states may supplement only certain benefits, such as dental 
care, mental health care, or immunizations. 

[18] The authority under which a premium assistance program operates 
determines whether or not the program has to provide benefits 
wraparound coverage. For example, programs operating under section 
1115 waivers may not have to provide benefits wraparound coverage. Of 
the nine programs that provided no benefits wraparound coverage, two 
had a mandatory enrollment policy for eligible individuals. 
Additionally, three of the nine programs that provided no benefits 
wraparound coverage subsidized premiums for nongroup coverage. 

[19] Of the 34 programs that reported paying at least some cost 
sharing, 21 reported paying all cost sharing for all eligible 
individuals covered through premium assistance, 12 reported paying 
some cost sharing for all eligible individuals, and 1 reported paying 
all cost sharing for some eligible individuals and no cost sharing for 
the other eligible individuals. Additionally, 1 program reported 
paying some cost sharing for noneligible family members. 

[20] Of those 11 programs that did not pay cost sharing for any groups 
covered by premium assistance, 2 programs were mandatory programs, in 
that individuals eligible for premium assistance were required to 
enroll. 

[21] Data were generally for the 12-month period from July 1, 2008, 
through June 30, 2009, and included both the state and federal share. 

[22] Additionally, 24 of the 35 programs that provided benefits 
wraparound coverage did not report the amount of expenditures in this 
category. Twenty-six of the 34 programs that paid some cost sharing 
did not report the amount of expenditures in this category. 

[23] Section 3910 of the State Medicaid Manual states that an 
individual's enrollment in premium assistance is cost-effective if the 
amount paid for premiums, coinsurance, deductibles, other cost 
sharing, as well as administrative costs, is likely to be less than 
the Medicaid expenditures for an equivalent set of services. To 
determine whether premium assistance is cost-effective, section 3910 
offers a calculation states can use. This calculation--referred to as 
the Secretary's method--involves a seven-step process that takes into 
account information on the group health plan; average Medicaid costs; 
Medicaid cost for services included in the group health plan; the 
group health plan cost for included services; an adjustment for 
coinsurance and deductible amounts; and additional administrative 
costs for processing the group health plan information. States that 
use another method for determining cost-effectiveness must have their 
methodology approved by CMS. 

[End of section] 

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