Background

The weakened economy continues to pose a threat to employment stability, triggering a reversal of the decline in the welfare caseload in many states and an increase in the number of working families without health insurance. At the same time states are seeking ways to meet their constitutional obligation for a balanced budget, they are facing new challenges to meet the health insurance needs of displaced workers and their families.

Prior to the current economic instability, many states were exploring ways to expand public and private health insurance coverage for the growing low-wage labor market. Public coverage was expanded as employer-based coverage for low-wage workers decreased. As a result, Medicaid and the State Children’s Health Insurance Program (SCHIP) now provide coverage for pregnant women and children and, in some states, coverage for working poor adults with and without children. Several states used state funds to pursue coverage for these populations, including partnerships with the private sector to encourage expansion of employer-based coverage and other private insurance market expansions. The worsening fiscal situation in states threatens to stall these efforts while the number of uninsured working poor increases.

In the new economic climate, it is likely that some low-wage workers will cycle between jobs and the welfare rolls one or more times before finding more permanent employment. It is also likely that many of them will be without health insurance for at least a short time. Their access to insurance coverage will depend on their insurance status while employed, their prior involvement with the welfare system, and their success in finding and retaining new jobs. However, it is estimated that only about one-third of low-income, newly unemployed workers will have received employer-based coverage while employed (Zuckerman et al., 2001). Although others may have been eligible for Medicaid through state expansions of income eligibility standards or for Transitional Medicaid Assistance during the first year after leaving welfare for work, frequent moves between jobs and the welfare rolls can result in changing eligibility for both private and public health insurance.

Growth in the number of uninsured, even on a temporary basis, can have serious implications for personal health status and for state economies. Uninsured workers are less likely to receive adequate and timely health care and, as a result, suffer more serious illnesses that threaten their work productivity and job retention. In addition, any increase in the demand for health care by the uninsured can strain the capacity of safety net providers and lead to increases in public health expenditures.

This Issue Note seeks to help policymakers identify ways to balance competing pressures. On the one hand, they must address the budget shortfalls caused by the weakening economy. On the other hand, they must address short- and long-term access to private and public health insurance for the growing number of newly unemployed, low-income workers.

Policy Issues

State fiscal and political situations may preclude widespread health insurance reforms to address the growing number of uninsured. Yet states may be able to build on existing policies to meet the short-term coverage needs of unemployed, low-income workers, some of whom may cycle in and out of employment and on and off the welfare rolls.

What types of health insurance coverage can meet the needs of newly unemployed, low-income workers? Short- and long-term public and private health insurance coverage for the working poor experiencing periods of unemployment depends on their health insurance status prior to their job loss and their level of income and assets subsequent to losing employment.

• Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA). Workers who received health insurance through their employer may be eligible for extended coverage under the federal COBRA option. This option allows individuals to retain their employer-based coverage during short spells of unemployment or during the transition to a new job. Employees choosing COBRA coverage must pay for the full cost of the premium and are eligible for the coverage for up to 18 months.  The COBRA option may provide needed coverage for some low-income unemployed workers. However, many may not be eligible because they worked for small employers that are not required to offer COBRA, they did not receive employer-based coverage while employed, or they were employed by firms that have gone out of business or cancelled their group health plan. Still others may not be able to afford to pay the full cost of the premium.

• Some states have established private coverage continuation programs that are similar to COBRA but apply to smaller employers. A few states have established subsidy programs to assist with COBRA premium costs. In addition, recent congressional debate over a federal economic stimulus package included consideration of federal subsidies for COBRA premiums. Although subsidizing COBRA will increase the number of low-income families that can opt for this coverage, some argue that eligibility limitations and high premium costs will still pose barriers to COBRA coverage for most low-income displaced workers. For more information, see Zuckerman et al., 2001.

• Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA provides important protections for low-income workers who succeed in moving from unemployment to jobs that offer health insurance coverage. The law protects newly employed workers and family members with preexisting health conditions by limiting the exclusion of those conditions from coverage and prohibiting premium payment structures that are based on health status. These protections are especially important for low-income workers, who may be at higher risk for health problems because of inadequate access to health care and poor living environments. For more information, visit http://ask.pwba.dol.gov.

• Transitional Medicaid Assistance (TMA). Some newly unemployed, low-income workers are likely to be recent recipients of cash assistance under the Temporary Assistance for Needy Families (TANF) program and, therefore, may still be receiving or be eligible for TMA. TMA provides for the continuation of Medicaid benefits for up to 12 months for individuals who have increased their earnings through employment above the TANF eligibility limit and might otherwise not have access to public or private health insurance. Several states have increased the duration of benefits and expanded eligibility standards to compensate for the lack of employer-based insurance in many sectors of the low-wage labor market. For more information, see Kaplan, 1997; and Health Care Financing Administration, 1999.

• State Medicaid Expansions. Recent state Medicaid expansions targeting low-wage working parents may address the short-term coverage needs of the growing number of newly unemployed workers without access to COBRA or other private coverage. States have broadened income and resource eligibility standards to provide Medicaid to families with higher incomes and assets. They are also extending coverage to two-parent families in which the primary wage earner works more than 100 hours per month, eliminating the “100-hour rule.” Many of these changes have been implemented with the new flexibility afforded states under Section 1931 of the federal welfare law, while others were enacted through Section 1115 waivers of the federal Medicaid law.  

• Subsidies of Private Insurance Premiums. Federal Medicaid law allows states to use Medicaid funds to pay insurance premiums for eligible workers. A premium subsidy can make employer-based coverage more affordable for low-income workers, and it may be more cost-effective for state Medicaid programs than other Medicaid expansions. Medicaid’s Health Insurance Premium Payment (HIPP) program allows states to subsidize employer-based insurance for eligible adults when it is more cost-effective than enrolling them in Medicaid. SCHIP also allows states to subsidize eligible families’ employer-based health insurance. Although some states have not used these options because they can be administratively burdensome, a few have done so in order to preserve limited public funds while encouraging employer-based coverage. For more information, see Conwell and Short, 2001.

• Health Insurance Flexibility and Accountability Initiative (HIFA). This new federal initiative encourages comprehensive state approaches to increasing health insurance coverage for populations not previously eligible for Medicaid or SCHIP, such as childless adults. The U.S. Department of Health and Human Services has promised to simplify and expedite the application and review process for state HIFA applications. Consequently, this initiative may be attractive to states that want to use existing Medicaid and SCHIP resources to meet the short-term insurance needs of newly–unemployed, low-income workers. However, some states may be reluctant to seek a HIFA waiver because it requires reallocating Medicaid and SCHIP resources to cover new populations. For more information, see Henneberry, 2001; or visit http://www.hcfa.gov/medicaid/hifa/default.htm.  

• Coverage for Children of Unemployed Workers. States may see an increase in the numbers of children covered by SCHIP and Medicaid if unemployment rates remain high and new children enter the welfare rolls. Both programs can also provide ongoing coverage for enrolled children while their parents are changing jobs. A few states are covering family members of SCHIP-eligible children and receiving enhanced federal matching funds. For more information, see National Health Policy Forum, 2001.  

• State-Funded Coverage. States have used state funds to expand coverage for the working poor and have designed their own benefits package, eligibility standards, and cost-sharing requirements. They also have worked closely with the private sector to expand coverage through premium subsidies, changes in the tax code to encourage employer-based coverage, and private market reforms. Although some of these state-based initiatives and private market reforms target specific populations with high medical costs and others may be experiencing budget cuts, they can be a source of short-term coverage for newly–unemployed, low-income families. For more information, visit http://www.state.coverage.net/matrix-intro.htm; or see Center on Budget and Policy Priorities, 2001.

How can states inform low-income workers who may be cycling in and out of jobs and on and off the welfare rolls about their health insurance options? Informing newly unemployed, low-income workers about their health insurance options can be a challenge for states that are already struggling to balance budgets and have scaled back their health insurance education and outreach programs and administrative systems. However, states can take some low-cost steps to provide timely information about insurance coverage.

States can model their efforts after the aggressive outreach campaigns that have been effective in increasing enrollment in SCHIP. For example, successful SCHIP outreach has hinged on interagency coordination. States may want to consider ways to improve coordination and communication among public agencies and between public and private entities that interact with low-income, unemployed workers and their families. These include state and local labor, unemployment insurance, social services, Medicaid, workforce development, housing, child welfare, and education agencies, as well as community-based service providers and the business community. Interagency coordination can enhance outreach planning, reduce duplication, allow for cross-training of staff, preserve scarce resources, improve information flow, and ensure seamless service delivery aimed at providing timely information to all clients regardless of their employment status. In addition, the SCHIP outreach model has centered on the coordination of state and local public and private agencies to conduct multimedia ad campaigns that use culturally sensitive materials in multiple languages; to create or expand helplines that provide information on insurance options; and to use outstationed workers to provide information in community-based settings, such as schools, churches, and community centers. For more information, see Wegener, 1999; or visit http://www.cbpp.org/shsh/.

States can also partner with the private sector and the workforce development community to encourage employers who are experiencing layoffs to disseminate insurance information to their employees and persuade more stable employers to conduct outreach efforts with their low-wage workers. Business partnerships can be a source of funding for outreach campaigns. Partnerships with one-stop career center systems created under the Workforce Investment Act (WIA) and other employment-related service delivery and outreach initiatives can provide information about public and private insurance options to displaced workers seeking employment-related services. For more information, see the Welfare Information Network, 2000; Golonka, 2000; and the Health Care Financing Administration, 1999.

Finally, integrated automated systems across agencies can play a critical role in identifying and tracking individuals and families as their employment circumstances and health insurance status change. In many states these systems can identify and screen potential beneficiaries among newly unemployed workers when they seek assistance from other public agencies, such as food stamps and housing, and can track health benefits for new TANF cases that have resulted from job displacement. Technological modifications that support and enhance screening tools used across agencies can also ease administrative burdens on staff.

How can states ease enrollment into public health insurance programs for low-income workers who are cycling in and out of work and on and off the welfare rolls? Several cost-effective approaches can help low-income families enroll in existing or newly expanded health insurance programs and enable them to continue receiving benefits during times of employment instability. States may find that many of the strategies they have used to promote and ease enrollment in their SCHIP and Medicaid programs can be adapted to address the needs of newly-unemployed, low-income workers and their families. For example, state modifications of the asset tests used to determine Medicaid eligibility simplify the application process and potentially expand access to benefits for newly unemployed workers who may have suffered a loss of income but may retain some assets. States also have made great strides in creating a more user-friendly application form and in reducing the form’s length and complexity by simplifying and clarifying the instructions and making it available in foreign languages. They can make these streamlined forms available in workforce development and other sites serving displaced workers. In addition, many states have developed unified or combined application forms for multiple public benefits programs. These forms enable newly unemployed families to apply for assistance quickly and help them continue to receive any prior benefits without interruption. Uniform application forms can be helpful in easing the transition among health insurance programs as income levels fluctuate, particularly if they also provide information required for private health insurance benefits, such as COBRA.

Although federal law requires authorized state personnel to perform eligibility determinations, it does not limit the location of application sites or participation of other individuals to help with the application process. Application forms can be made available in settings that are convenient and familiar to low-income families and that are staffed with volunteer or paid workers who can overcome cultural and language barriers to assist applicants in completing the form. States can place eligibility workers in one-stop career centers, unemployment insurance offices, and other workforce development settings. In addition, they can expand hours of operation to include evenings and weekends to increase access to services. Finally, states can consider mail-in, phone-based, and web-based applications.

States can also consider ways to simplify their TMA policies, particularly for former TANF recipients who may not have enrolled when they initially left welfare for work. One way to ease TMA enrollment is to eliminate, through a federal waiver, the requirements that recipients must have received cash and Medicaid assistance for three of the six months prior to seeking TMA benefits and that they must report income and reapply after six months. For more information, see Kaplan, 1997. Enrollment in other public health insurance programs, including expanded coverage under SCHIP, can also be simplified by changing eligibility policies aimed at preventing “crowd-out,” which occurs when public coverage is substituted for available private insurance. For example, some states have modified their “look-back” periods, which limit eligibility for SCHIP and other public programs to individuals or families that have not been offered or received private coverage for a designated period. State exceptions for newly-unemployed individuals  can expand access for workers who had employer-based coverage while working but who cannot afford COBRA or other state private insurance continuation programs. For more information, visit http://www.ncsl.org/programs/health/crowdout.htm.

In addition, states can work with private insurers and the business community to enhance access to COBRA and other private coverage options by making information and application forms available through one-stop career centers and by encouraging mail-in, phone-based, and web-based applications. Automated systems that link client eligibility information between public and private programs can improve information flow and reduce the paperwork burden on applicants. States will need to address confidentiality issues when setting up linked client information systems.

Reenrollment and eligibility redetermination procedures and requirements can also be eased for displaced workers and their families that were receiving public health insurance benefits when they lost their jobs. States are increasingly adopting 12-month continuous Medicaid eligibility for families with children to ensure ongoing coverage regardless of changes in family income or circumstances. In addition, automated systems can eliminate some reenrollment hurdles by tracking program participation and the continuation of coverage under Medicaid, SCHIP, and other public health insurance programs. These systems can serve as a repository of application information, eliminating the need for clients to resubmit information during the redetermination process. Application and enrollment simplification measures, such as outstationing workers and allowing for mail-in, phone-based, and web-based applications, can also be used for reenrollment and redetermination. States also might review their notices for benefit redeterminations to ensure they are written in a culturally sensitive manner, are easy to read, are available in several foreign languages, are sent in a timely manner, and require only the most essential documentation. They can also consider alternative methods to notify clients of upcoming redeterminations, including home visits, phone calls, and collaborations with other agencies and programs that provide services to newly unemployed families. For more information, see Golonka, 2000; and Health Care Financing Administration, 1999.

Finally, states can work with public and private providers of health care to ensure that access to care is not compromised by changes in health insurance coverage and status among newly unemployed workers. One approach would require health plans to take all “comers” with any type of public or private coverage, regardless of prior payer policies.

How can states expand public health insurance coverage for low-income, newly unemployed workers in the short term? States can use several approaches to expand public health care programs to cover the newly unemployed who cannot afford, or are not eligible for, COBRA or other private coverage. They can extend the duration of TMA for eligible former TANF recipients who are not reemployed after the 12-month limit, increase the TMA income limit, or eliminate the requirement that recipients had to have received Medicaid while on cash assistance for three of the six months prior to seeking TMA. These changes would require a federal waiver, which can be a resource-intensive and burdensome process. States can also provide continuous eligibility for adults to enable them to receive Medicaid coverage during periods of income instability or eliminate the assets test when determining adult eligibility for Medicaid benefits. In addition, states can use unspent SCHIP funds to expand coverage for parents. Five states have already received federal waivers to establish family coverage under SCHIP, and several other waiver applications are pending. Time, budget, and administrative constraints may deter some states from pursuing this option. Some states may want to consider coverage expansions through a federal HIFA waiver, which has simplified application procedures and will receive an expedited federal review. However, any expansions achieved through HIFA require the reallocation of SCHIP and Medicaid resources. Alternatively, states can strengthen or expand their state-funded health insurance programs. Although states will not receive federal matching funds for state-funded initiatives to cover the unemployed, these programs can be implemented quickly and are not subject to lengthy federal waiver procedures, regulations, and oversight. For an in-depth discussion of state options to cover the working poor, see Kaplan, 2000.

What Medicaid cost savings could states consider to enable them to cover the newly unemployed and uninsured? The growth in Medicaid spending has exacerbated the fiscal crisis confronting many states. Policymakers are being forced to find ways to stem that growth while addressing the needs of newly unemployed and uninsured families. Moreover, the constitutional requirement in most states for a balanced budget has led to a reticence to lose federal Medicaid matching funds through program cuts.

State approaches to these competing pressures could take several forms. States are looking for ways to preserve Medicaid programs. In addition, they are looking for new funding sources to support expanded coverage to address the needs of the newly unemployed. For example, states could use reserve or “rainy day” funds, created during earlier economic expansions, to maintain and/or expand Medicaid. They could also tap into the funds they received through the recent tobacco settlement agreement. Although these funds may be useful in the short term, they are not an ongoing funding source. States could use increases in fees and taxes, including taxes on health care providers or tobacco, to support their Medicaid spending and meet budget shortfalls. Moreover, several bills introduced in Congress propose to increase federal Medicaid support during the current economic downturn, which would enable states to maintain, and possibly expand, their current programs.

At the same time states are looking for alternative funding sources, they are considering program cutbacks to slow expenditures. State policymakers face numerous political, philosophical, fiscal, and ethical challenges as they try to balance fiscal realities with the need to comply with federal Medicaid mandates and to provide a basic level of care for their most needy. Cost-saving strategies that have been proposed in some states include increased client cost-sharing requirements; reduced benefits for optional beneficiaries; cuts in reimbursements to hospitals, nursing homes, pharmacists, or other providers; elimination of certain optional benefits, such as coverage for eyeglasses, podiatry, and dental care; and limits on prescription drug coverage. In addition, some states are considering eliminating or limiting optional coverage groups, such as the medically needy, pregnant women and children with family income above a certain level, and childless adults.  States also are considering administrative cost savings through cutbacks in staff, decreased education and outreach activities, and other strategies. Advocates for preserving Medicaid services argue that cutting state Medicaid expenditures results in significant losses of federal revenues for states, threatens the economic viability of the health care sector, and threatens Medicaid’s role as a safety net for the neediest citizens. For more information, see Kaiser Commission, 2001; and Ku and Rothbaum, 2001.

Research Finding

A recent survey of Medicaid eligibility staff in all 50 states and the District of Columbia looked at the availability of public and private health insurance coverage for the working poor as a result of eligibility changes that states have made under Section 1931 of the TANF law. The survey found that 17 states and the District of Columbia currently enroll families, including parents, with incomes up to 100 percent of the poverty level in Medicaid. Sixteen states do not administer an asset test when determining Medicaid eligibility for a parent, and several other states have liberalized the asset test requirements. Sixteen states waive the rule under TMA that families must have received Medicaid while on cash assistance for three of the six months prior to seeking TMA assistance. Fourteen states allow families to receive TMA for longer than 12 months, and 37 states have a policy of continuous eligibility for 12 months for families with children. (Center on Budget and Policy Priorities, 2001).

An analysis of private insurance coverage among welfare leavers found that 23 percent of adult leavers and 27 percent of child leavers reported they had coverage. Of the welfare leavers who were working at the time of the study, approximately one-third were covered by private insurance (Garrett and Holahan, 2000). The Commonwealth Fund’s 2001 Health Insurance Survey found that only 40 percent of workers between the ages of 19 and 64 who had family incomes below 200 percent of poverty may be eligible for COBRA (Duchon, 2001). Another study looked at data from the 1999 National Survey of American’s Families and found that 68 percent of all workers with incomes below 200 percent of poverty would be ineligible for COBRA if they became unemployed. When the researchers examined actual COBRA enrollment data for all income levels, they found that only 7 percent of unemployed adults had coverage under COBRA insurance and 46 percent of all unemployed adults without COBRA coverage had no other form of health insurance (Zuckerman et al., 2001).

Researchers have developed simulations to project the impact of increases in unemployment on uninsurance rates and estimate the demand for Medicaid. One statistical model projects an increase of 85 uninsured for every 100 people who become unemployed. The model also shows a related drop in employer-based coverage and an increase in the number of people receiving public coverage (Gruber, 2002). An analysis by The Urban Institute, based on earlier research that found a statistically significant relationship between unemployment rates and Medicaid enrollment, projects that a 1-percent increase in the unemployment rate would result in a 3.6-percent increase in the number of Medicaid enrollees (Holahan and Garrett, 2001).

Several studies have examined the extent of coverage that could be achieved through different private and public insurance expansions targeting low-income, unemployed workers. One study found that high COBRA premium costs would continue to be a barrier for many low-income families, even with a high subsidy level. According to this analysis, a 50-percent subsidy would result in a 55-percent COBRA participation rate (Lambrew, 2001). Findings from a study of the increasing number of state and local premium subsidy programs indicate their limited effectiveness in expanding coverage through employer-based insurance. The study estimated that a 30-percent employer premium subsidy would increase coverage for about 500,000 of the 16 million employees of small firms not previously offering health insurance. It concluded that large and costly subsidies are needed to significantly increase coverage rates. In addition, numerous barriers to implementation need to be addressed, including complex regulatory requirements and difficulties in designing benefit packages (Reschovsky and Hadley, 2001). Finally, researchers have projected the impact of a proposal to change the federal Medicaid law to give states the option to cover unemployed workers with incomes below 200 percent of poverty. According to the analysis, approximately 56 percent of low-income unemployed adults would become newly eligible for Medicaid under this coverage expansion (Zuckerman, et al., 2001).

Innovative Practices

State initiatives to address the health insurance needs of newly-unemployed, low-income workers and their families include outreach and education strategies, one-stop shopping for information and enrollment, administrative streamlining, and targeted coverage expansions. For more examples of state and local initiatives, visit http://www.welfareinfo.org/healthcare.asp#State%20Specific%20Initiatives.  

Arizona was the first state to receive a waiver under the federal HIFA Initiative. The state will use SCHIP funds to expand coverage to childless adults above age 18 with adjusted net family income below 100 percent of the federal poverty level. Coverage will also be expanded to parents of children enrolled in Medicaid or SCHIP with adjusted net family income between 100 percent and 200 percent of the poverty level. Expenditures will be limited to available funds from the state’s SCHIP allotment. SCHIP-eligible children and the parents of children covered by SCHIP and Medicaid will be given priority for coverage. Recipients will be subject to cost-sharing requirements. Contact Vince Wood at 602/542-3596.

The Medical Security Plan, a program of the Massachusetts Division of Employment and Training, provides temporary health care coverage for unemployment insurance (UI) claimants. The program subsidizes COBRA or covers the costs of a comprehensive benefits package for those who do not have the option of continuing private coverage. Medical Security Plan coverage ends when UI eligibility ends. Contact Craig Paton at 617/626-6613; or visit http://www.detma.org/claimant/msp.htm.

Minnesota informs employers about Medicaid through mass mailings, presentations to small businesses, and job fairs. Employers are encouraged to use paycheck inserts and other methods to educate their employees about the program. The state also provides Medicaid information directly to recently unemployed workers. Contact Kathleen Henry at 651/282-6494. Wisconsin’s one-stop job centers and tribal welfare-to-work offices provide Medicaid information and are certified to enroll clients. Contact the Department of Health and Family Services at 608/266-1865.

NJFamily Care is a federal and state-funded health program to give uninsured New Jersey families access to affordable health coverage. Prior to September 1, 2001, the program accepted applications for coverage for single adults and couples without children. Eligibility is based on family size and monthly income; assets are not considered. It is limited to families that have been uninsured for six months prior to applying for the program, except when an applicant’s place of work goes out of business or experiences a workforce reduction. Applications can be completed through the mail with enrollment packets that contain postage-free envelopes. NJFamily Care includes a premium assistance program. Contact Heidi Smith at 609/588-3526; or visit http://www.njfamilycare.org.

New York’s Disaster Relief Medicaid/Family Health Plus allowed New York City residents meeting the income standards for Medicaid or the state program, Family Health Plus, to receive four months of Medicaid coverage with a limited eligibility review. (Family Health Plus is the state’s public health insurance program for adults between the ages of 19 and 64 who have incomes too high to qualify for Medicaid.) The application consisted of a one-page form detailing the name of the person applying for coverage, any other health insurance, the number of people in the household, and the household’s income. Applicants were not required to provide documentation. Applications were accepted through January 31, 2002, and coverage will last four months postenrollment. Medicaid was automatically extended for one year for any recipient who was due to recertify for coverage during the four-month period prior to January 31, 2002. Contact the Family Health Plus Program at 518/473-5330; or visit http://www.health.state.ny.us/nysdoh/fhplus/disaster.htm.

The Robert Wood Johnson Foundation’s State Coverage Initiative is a three-year, $6-million initiative to help state governments develop and implement policies that extend health care coverage to previously uninsured adults. To date, four states have received large demonstration grants through this program. Contact Gerald Wilson at 202/292-6731 or wilson@ahsrp.org; or visit http://www.statecoverage.net.

The U.S. Health Resources and Services Administration’s provides one-year grants to states to develop plans for giving uninsured citizens access to affordable health insurance. To date, 20 states have received these state planning grants. The federal agency recently announced that funds were available for another 10 states. Contact the Academy for Health Services Research and Health Policy at 202/292-6700; or visit http://www.statecoverage.net.

Resource Contacts

·         Center on Budget and Policy Priorities, Leighton Ku, 202/408-1080; or http://www.cbpp.org/pubs/health.htm.

·         Center for Studying Health System Change, Richard Sorian, 202/484-5261; or http://www.kff.org/docs/sections/kcmu/about.html.

·         The Commonwealth Fund, Cathy Schoen, 212/606-3800 or cs@cmwf.org.

·         Covering the Uninsured, http://www.coveringtheuninsured.org/.

·         Families USA, Rachel Klein, 202/628-3030; or http://www.familiesusa.org.

·         Heritage Foundation, Stuart Butler, 202/546-4400.

·         Institute for Health Policy Solutions, Lynn Taylor, 202/789-1491 or ltaylor@ihps.org.

·         Kaiser Commission on Medicaid and the Uninsured, Dawn Nelson, 202/347-5270; kcmu@kff.org; or http://www.kff.org/docs/sections/kcmu/about.html.

·         National Governors Association, Joan Henneberry, 202/624-3644.

·         National Health Policy Forum, Judith Moore, 202/872-1390 or http://www.nhpf.org.

·         Pension and Welfare Benefits Administration, U.S. Department of Labor, Richard Hinz, 202/693-8410; or http://www.dol.gov/dol/pwba/public/pubs/disloc1.htm. 

·         The Urban Institute, Stephen Zuckerman, 202/261-5679.

·         U.S. Center for Medicare and Medicaid Services, Marty Svolos, 410/786-4582 or msvolos@hcfa.gov.

Publications

Center on Budget and Policy Priorities. Expanding Family Coverage: States’ Medicaid Eligibility Policies for Working Families in the Year 2000. Washington, D.C.: Center on Budget and Policy Priorities, December 2001. Available at http://www.centeronbudget.org.

Conwell, Leslie Jackson, and Ashley Short. Premium Subsidies for Employer-Sponsored Health Coverage. An Emerging State and Local Strategy to Reach the Uninsured. Washington, D.C.: Center for Studying Health System Change, December 2001. Available at http://www.hschange.org/CONTENT/393/?topic=topic13.

Duchon, Lisa, et al. Security Matters: How Instability in Health Insurance Puts U.S. Workers at Risk. New York, N.Y.: The Commonwealth Fund, December 2001. Available at http://www.cmwf.org/programs/insurance/duchon_securitymatters_512.pdf.

Garrett, Bowen, and John Holahan. Welfare Leavers, Medicaid Coverage, and Private Health Insurance. Washington, D.C.: The Urban Institute, March 2000. Available at http://newfederalism.urban.org/html/series_b/b13/b13.html.

Golonka, Susan. State Outreach and Enrollment Strategies to Improve Low-Income Families’ Access to Medicaid. Washington, D.C.: National Governors Association, September 15, 2000. Available at http://www.nga.org/center/.

Greenstein, Robert, and Jocelyn Guyer. “Supporting Work through Medicaid and Food Stamps.” In The New World of Welfare, ed. Rebecca Blank and Ron Haskins. Washington, D.C.: The Brookings Institution, 2001. Available at http://www.brookings.edu.

Gruber, Jonathan, and Larry Levitt. Rising Unemployment and the Uninsured. Menlo Park, Calif.: The Kaiser Family Foundation, January 2002. Available at http://www.kff.org/content/2001/6011/.  

Health Care Financing Administration. Supporting Families in Transition: A Guide to Expanding Health Coverage in the Post-Welfare Reform World. Washington, D.C., March 1999. Available at http://www.hcfa.gov/medicaid/welfare.htm.

Henneberry, Joan. HIFA: Finding the Flexibility. Washington, D.C.: National Governors Association, October 24, 2001. Available at http://www.nga.org/center.

Holahan, John, and Bowen Garrett. Rising Unemployment and Medicaid. Washington, D.C.: The Urban Institute, October 16, 2001. Available at http://www.urban.org/pdfs/HPOnline_1.pdf.

Kaiser Commission on Medicaid and the Uninsured. The Role of Medicaid in State Budgets. Washington, D.C.: The Henry I. Kaiser Family Foundation, October 2001. Available at http://kff.org/content/2004/4024/4024.pdf.

Kaplan, Jan. State Options to Increase Health Insurance for the Working Poor. Washington, D.C.: Welfare Information Network, June 2000. Available at http://www.welfareinfo.org/janjune.htm.

Kaplan, Jan. Transitional Medicaid Assistance. Washington, D.C.: Welfare Information Network, December 1997. Available at http://www.welfareinfo.org/transmedic.htm.

Ku, Leighton, and Emily Rothbaum. Many States Are Considering Medicaid Cutbacks in the Midst of the Economic Downturn. Washington, D.C.: Center on Budget and Policy Priorities, October 26, 2001. Available at http://www.cbpp.org/10-24-01health.htm.

National Health Policy Forum. Health Insurance Family Style: Public Approaches to Reaching the Uninsured. Washington, D.C.: National Health Policy Forum, September 24, 2001.  Available at http://www.nhpf.org.

Neuschler, Ed, and Lynn Taylor. Covering Displaced Workers and Their Children: Issues and Alternatives. Washington, D.C.: Institute for Health Policy Solutions, January 2002. Available at http://www.ihps.org.

Reschovsky, James D., and Jack Hadley. Employer Health Insurance Premium Subsidies Unlikely to Enhance Coverage Significantly. Washington, D.C.: Center for Studying Health

System Change, December 2001. Available at http://www.hschange.org/CONTENT/392/?topic=topic03.

Rowland, Diane. Health Insurance for Unemployed Workers. Washington, D.C.: Kaiser Commission on Medicaid and the Uninsured, October 2001. Available at http://www.kff.org/content/2001/4018/.

Springer, John and Heidi Goldberg. Relieving the Recession:  Nineteen Ways States Can Assist Low0Inocme Families During the Downturn. Washington, D.C.: Center on Budget and Policy Priorities, February 2002. Available at http://www.cbpp.org/2-22-02wel.pdf.

Wegener, Victoria. Children’s Health Insurance Program—Outreach and Enrollment. Washington, D.C.: Welfare Information Network, May 1999. Available at http://www.welfareinfo.org/chipissuenotes.htm.

Welfare Information Network. One-Stop Centers: Recent Developments. Washington, D.C.: Welfare Information Network, August 2000. Available at

http://www.welfareinfo.org/resourcesonestopcentersrecentdevelopments.htm.

Zuckerman, Stephen, et al. Could Subsidizing COBRA Health Insurance Coverage Help Most Low-Income Unemployed? Washington, D.C.: The Urban Institute, October 17, 2001. Available at http://www.urban.org/pdfs/HPOnline_2.pdf.

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