Cost and Coverage: The Impact of Implementing Various State Health Care Reform Proposals Nationally. Eligibility


Eligibility guidelines for premium subsidy program participation vary widely, but income is a key consideration across all programs.  Premium subsidies are meant to provide increased access to coverage by improving health insurance affordability for populations for whom financial limitations make take-up less likely.  By definition, this population therefore consists of low-income individuals and families.  Low-income is typically defined as at or below 200% FPL, but many programs limit eligibility to lower income levels and some go further up the income scale.   For example, Utah provides subsidies for working adults with income up to 150 percent FPL and for children in families with income up to 200 percent FPL, while states such as Massachusetts and Vermont subsidize coverage for populations with income up to 300 percent FPL.

In determining what income groups to allow into a premium subsidy program, states consider factors such as how much funding is available for the program, the cost of the subsidy per participant, the number of uninsured by income levels, and what other programs exist that provide access to coverage for low-income populations in their state.  In addition to the above, there are often other requirements for participation related to age, employment status, marital and/or parental status, residency, and duration of uninsurance.

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