State-sponsored children's health insurance programs

Most states offer some type of low-cost health insurance for eligible children. Usually, the child must be younger than 18 and live in a family with a family income at or below 200% of the Federal poverty line for a family of the size involved. The program covers doctor visits, medicines, hospitalizations, dental care, eye care, and medical equipment. It is funded by state tax dollars. Children enrolled in Medicaid (see "What is Medicaid?" in the section "Government-Funded Health Plans.") usually are not eligible for state-sponsored health insurance programs.

State laws that may affect coverage

People with health problems are often denied private health insurance or have trouble finding coverage they can afford. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides nationwide standards and a guarantee of access to health insurance coverage in the individual market for some people who are losing group health insurance coverage (see section on HIPAA). But this doesn't mean that you will be able to afford it or that coverage will be adequate.

All states are different. Some states have special laws requiring that insurers offer health insurance to anyone who applies. This is called guaranteed issue. A few states also limit the premium the insurance company can charge, even if a person has a pre-existing condition. This is called community rating. If you live in a state that requires community rating, you are not likely to need insurance risk pools.

Health insurance risk pools

A number of states now sell comprehensive health insurance to state residents who have serious medical conditions and can't find a company to insure them. Health insurance risk pools are special programs created by states to provide health insurance for the "medically uninsurable." These are people who have been denied health insurance coverage because of a medical condition, or who have physical conditions that make them unable to purchase health insurance at any price.

At present, 34 states have risk pools. They are non-profit associations and in most states are not funded by tax dollars. Risk pools require you to pay premiums, but some have programs so that low-income people do not have to pay as much.

Who is eligible to take part in a risk pool?

People applying for plan coverage must live in that state, including children. State laws or regulations outline other requirements. They may require proof that you were rejected for health insurance by private insurers. Sometimes they will let insured people join if their premiums would be lower in the risk pool. Many of the state plans do not let you apply for the risk pool if you are eligible for or are getting Medicare or Medicaid. Some states make each person apply individually for the pool, but most allow a parent to enroll a dependent child. Check with your state to learn whether your child qualifies and the cost to enroll.

Many states have also placed an enrollment cap on their plans. This means the plan will accept only a certain number of people into the plan at any one time. People who apply for coverage after that limit is reached must go on a waiting list to get into the plan. Look at the section "States that have risk pools" for a list of states and contact information.

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Last Medical Review: 04/01/2009
Last Revised: 04/01/2009