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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

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.

State 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)
toll-free.

High-Risk Pools

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 individuals.

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.


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