In my former life as a CHIP director, I came to appreciate how tough it is for low-income families to make ends meet.  In the hierarchy of needs, I think we all agree that paying the rent and utilities, putting food on the table, and making sure you can show up for work by having stable childcare and transportation take priority. But what happens when the car engine blows up or your hours are cut at work? Will the entity collecting your health coverage premiums understand?

Despite efforts to align many policies, particularly relating to eligibility across Medicaid, CHIP and Marketplace coverage, a number of aspects of premium administration remain unaligned and sometimes undefined. In this new brief, CCF explores the various policies that relate to premium collection, grace periods and lockouts from coverage due to nonpayment of premium.

The evidence is clear that premiums that are unaffordable or charged at too low an income level are a barrier to enrollment and retention of health coverage. However, the approach to premium collection also plays an important role in helping low-income families and individuals secure and maintain coverage. As states seek to charge premiums at lower income levels in Medicaid, it’s worth a second look at how they administer premiums as well.