Other workers may be covered by their employer but unable to pay additional amounts for dependent coverage if it is offered. Prior to that, with the exception of low-income pregnant women and children, families could qualify for Medicaid only by meeting restrictive welfare eligibility requirements including, in most states, incomes well below the poverty level. This was intended to accomplish one of Congress' welfare reform goals, enabling families making the transition from welfare to work, or those who were never on welfare, to stay in the employment stream. The BadgerCare program established by the State of Wisconsin provides a good example. A number of states supplement their Medicaid and CHIP programs by using state-only revenues or other policy mechanisms.
Several examples are illustrative.
Massachusetts provides financial incentives to small employers to provide coverage to low-income workers through its Insurance Partnership Program. Washington State has integrated its coverage for state employees, Medicaid beneficiaries, and low-income workers, enhancing its purchasing power in negotiations with private plans. Oregon has developed a cooperative program with insurance agents for marketing and enrollment of low-income individuals in private policies that are subsidized by the state. There are several answers. Although funding is always an issue, administrative difficulties may be the larger reason for many states.