Medicaid Premium Assistance Programs: What Information is Available About Benefit and Cost-Sharing Wrap-Around Coverage?

States have long used Medicaid funds as premium assistance to purchase private health insurance for beneficiaries as an alternative to providing coverage directly through the state Medicaid program. States using premium assistance generally must provide wrap-around benefits and cost-sharing protections so that Medicaid beneficiaries receiving private coverage will not have access to fewer benefits or pay higher out-ofpocket costs when private coverage fails to meet Medicaid’s level of coverage or is more expensive. Some states seeking alternative ways to implement the Affordable Care Act’s (ACA) Medicaid expansion have been interested in expanding Medicaid premium assistance programs and adopting new models to purchase individual market coverage. These initiatives can be informed by an understanding of how pre-ACA premium assistance programs are working, particularly regarding wrap-around benefits and cost-sharing protections.

This issue brief examines states’ approaches to administering wrap-around benefits and cost-sharing in longstanding Medicaid premium assistance programs and the information available to beneficiaries about how to access these program features. We present findings based on our survey in 2014 of eight states (AL, LA, NV, RI, TX, UT, VT, and WI) that previously had reported spending dedicated to premium assistance wrap-around benefits to collect updated data and ascertain what states considering premium assistance in the Medicaid expansion context could learn about wrap-around benefits and cost-sharing based on long-standing premium assistance programs. We supplement our analysis by examining these states’ written materials designed to inform beneficiaries about premium assistance coverage and end with a discussion of post-ACA premium assistance programs.


Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.