![]() As of January 2017, 30 states charge premiums or enrollment fees and 25 states charge cost sharing for children in Medicaid or CHIP. Reflecting these options, premiums and cost sharing in Medicaid and CHIP vary across states and groups. Premiums and Cost Sharing in Medicaid and CHIP TodayĬurrently, states have options to charge premiums and cost sharing in Medicaid and CHIP that vary by income and eligibility group (Box 1). The effects on individuals, providers, and state costs reflect varied implementation of premiums and cost sharing across states as well as differing premium and cost sharing amounts. This research has primarily focused on how premiums and cost sharing affect coverage and access to care some studies also have examined effects on state savings. It draws on findings from 65 papers published between 2000 and March 2017, including peer-reviewed studies and freestanding reports, government reports, and white papers by research and policy organizations. This brief, which updates an earlier brief “ Premiums and Cost-Sharing in Medicaid: A Review of Research Findings ,” reviews research on the effects of premiums and cost sharing on low-income populations in Medicaid and CHIP. ![]() Proponents of increasing premiums and cost sharing in Medicaid indicate that doing so will promote personal responsibility, prepare beneficiaries to transition to commercial and private insurance, and support consumers in making value-conscious health decisions. ![]() Current rules limit premiums and cost sharing in Medicaid to facilitate access to coverage and care for the low-income population served by the program, who have limited resources to spend on out-of-pocket costs. Recently, there has been increased interest at the federal and state level to expand the use of premiums and cost sharing in Medicaid. Studies also show that raising premiums and cost sharing in Medicaid and CHIP increases pressures on safety net providers, such as community health centers and hospitals. Research shows that potential revenue gains from premiums and cost sharing are offset by increased disenrollment increased use of more expensive services, such as emergency room care increased costs in other areas, such as resources for uninsured individuals and administrative expenses. State savings from premiums and cost sharing in Medicaid and CHIP are limited.Additionally, research finds that cost sharing increases financial burdens for families, causing some to cut back on necessities or borrow money to pay for care. For example, studies find that increases in cost sharing are associated with increased rates of uncontrolled hypertension and hypercholesterolemia and reduced treatment for children with asthma. Research also finds that cost sharing can result in unintended consequences, such as increased use of the emergency room, and that cost sharing negatively affects access to care and health outcomes. Even relatively small levels of cost sharing in the range of $1 to $5 are associated with reduced use of care, including necessary services.Individuals who become uninsured face increased barriers to accessing care, greater unmet health needs, and increased financial burdens. Some individuals losing Medicaid or CHIP coverage move to other coverage, but others become uninsured, especially those with lower incomes. These effects are largest among those with the lowest incomes, particularly among individuals with incomes below poverty. Premiums serve as a barrier to obtaining and maintaining Medicaid and CHIP coverage among low-income individuals. ![]() This research has primarily focused on how premiums and cost sharing affect coverage and access to and use of care some studies also have examined effects on safety net providers and state savings. This brief reviews research from 65 papers published between 2000 and March 2017 on the effects of premiums and cost sharing on low-income populations in Medicaid and CHIP. ![]() Recently, there has been increased interest at the federal and state level to expand the use of premiums and cost sharing in Medicaid as a way to promote personal responsibility, prepare beneficiaries to transition to commercial and private insurance, and support consumers in making value-conscious health decisions. ![]()
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