Premium assistance programs use federal and state Medicaid and State Children’s Health Insurance Program (SCHIP) funds to purchase private coverage. Overall, few states have premium assistance programs, but interest in premium assistance remains high. This issue brief examines six state premium assistance programs (in Florida, Idaho, Illinois, Oregon, Utah, and Virginia) that allow families to choose to receive a subsidy to apply to the purchase of private coverage rather than to receive direct Medicaid or SCHIP coverage.