TABLE 6.1 State Initiatives to Expand Coverage to Children (as of May 1997)

Individuals Covered

Subsidy Programs for Children and Families

Subsidies to Employers

Other

 

State Only

State and Local

State and Private

 

 

Children

California

Florida

Iowa

 

 

 

Massachusetts

Colorado

Kansas

 

 

 

Minnesota

 

Michigan

 

 

 

New York

 

Montana

 

 

 

Pennsylvania

 

North Carolina

 

 

 

Vermont

 

New Hampshire

 

 

Families

Massachusetts (2)

 

 

Florida

Iowaa

 

New Jersey

 

 

Maine

New Yorkb

 

New York (2)

 

 

New York

Oregonc

 

Washington

 

 

Washington

 

a Tax deduction

b Pilot voucher program

c Tax credit to small employers

SOURCE: Gauthier and Schrodel (1997, p. 7).

living in low-income families. Four states had developed subsidy programs for families. In addition, private programs were operating in 25 states (Gauthier and Schrodel, 1997) (see Table 6.1).

As of May 1997, only six states (Alaska, Illinois, Indiana, Nebraska, Nevada, and South Carolina) had no public or private subsidized insurance programs and had not expanded Medicaid eligibility to children over age 1. Eight states (Alabama, Idaho, Louisiana, Mississippi, Ohio, Oklahoma, Texas, and Wyoming) had only private Blue Cross and Blue Shield Caring Programs for Children and provided no state assistance (Gauthier and Schrodel, 1997; Gehshan, 1997).

Many of the states choosing Medicaid expansions have considered the relative administrative and fiscal advantages of altering an existing program when compared with designing and implementing new state programs (Mann, 1997). Medicaid already has an administrative structure in place in every state, and its administrative costs are low. Medicaid's contracts and rates have already been negotiated and provider networks, payment systems, and benefit packages have been established. In addition, the federal matching payments provide an incentive to expand Medicaid by reducing the amount of money that states need to provide from their own budgets (Dorn et al., 1998; Mann, 1997).

However, some states have preferred to sponsor separate, independent programs that are distinct from Medicaid. Several states have funded programs that subsidize coverage for children through selected commercial insurance or managed care plans. The level of the subsidy typically varies on a sliding scale, with full subsidies for children from families with the lowest income levels and higher premium levels and copayments for children from families with higher levels of income. Some states



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