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6. What about other government programs?
Other government-sponsored programs for specific groups—such
as Medicaid and the State Children's Health Insurance
Program (SCHIP) for low-income individuals and families—and
plans that meet a specific need, such as long-term care, supplemental
coverage, and disability insurance, are also available.
Medicaid provides health care coverage for certain people
with limited income who are eligible to participate in the
program. Medicaid is a Federal-State program that is operated
by the States. Each State sets its own rules about eligibility
and covered services.
Many groups of people are eligible for Medicaid coverage.
Some of the factors affecting eligibility include age; whether
you are pregnant, blind, or disabled; your income and resources;
and whether you are a U.S. citizen or legal immigrant. Your
child may be eligible for coverage even if you are not. Eligibility
for children is based on the child's status, not the parent's status.
If your income is limited and you can't afford the care you need, you should
apply for Medicaid whether or not you think you qualify. A qualified caseworker
in your State will evaluate your situation to see if you are eligible for Medicaid.
For more information about the Medicaid program, go to http://www.cms.hhs.gov/MedicaidGenInfo.
Children's Health Insurance Program
Congress created the State Children's Health Insurance
Program (SCHIP) in 1997. SCHIP is a Federal/State partnership
similar to Medicaid. SCHIP expanded health insurance to children
whose families earn too much money to be eligible for Medicaid
but not enough to purchase private insurance.
Like Medicaid, SCHIP eligibility and covered services vary
from State to State. In some States, Medicaid and SCHIP are
combined. In other States, they operate as separate programs.
Although health benefits covered by SCHIP vary, all States
must provide coverage for well-baby and well-child care, immunizations,
and emergency services.
You can get more information about SCHIP online at http://www.insurekidsnow.gov.
This site provides a link where you can access specific information
about SCHIP in your State. Or, to get information by phone,
call 1-877-KidsNow (1-877-543-7669)
A high-risk pool is a State-operated program
that offers health insurance to individuals who don't
have access to coverage through an employer or other group
and have a serious medical condition that prevents them from
purchasing private health insurance. It is similar to risk
pools for automobile insurance to ensure coverage for people
who can't get it elsewhere. In most States, the risk
pool is funded through premiums, supplemented by tax revenues
or by an annual assessment on health insurance companies operating
in the State.
More than 30 States have established high-risk pools that
provide access to comprehensive health coverage for more than
180,000 people across the country. An estimated 1 million people
who are eligible for coverage in high-risk pools don't
participate. In a few cases, States don't have adequate
funding for the pools and are unable to enroll all eligible
To find out if coverage through a high-risk pool
is an option in your State, contact your State Insurance Commissioner.
Check the blue pages of your local phone book for contact information.