Medicaid coverage of children and pregnant women has been expanded several times since the late 1980s. However, recent data suggest that there are even greater problems of uninsurance among low-income adults. Low-income adults are more likely than children to be covered by employers but much less likely to be covered by public programs. As a result, they are substantially more likely to be uninsured. Recent data from the National Survey of America's Families show that 17 percent of adults at all income levels lacked health insurance, versus 12 percent for children.
States have several options to provide health insurance to adults who are uninsured.
Medicaid and state-funded programs to insure adults have been in existence for years, but recent legislation has created new opportunities under Medicaid and CHIP to obtain federal matching funds. The most important of these is Section 1931 of the Social Security Act, which considerably increases states' ability to extend Medicaid coverage to both parents and children in low-income families. States are also using interesting combinations of Section 1115, Section 1931, and CHIP funding authorities to craft new designs to cover adults. In this paper we describe in greater detail all of the available mechanisms that states have to cover low-income adults. We address what states are permitted to do under current law and what several states are currently doing or beginning to implement.