Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Sign up for MCHalert eNewsletter

Evidence Tools
MCHbest. Adequate Insurance.

MCHbest Logo

Strategy. Premium Assistance

Approach. Support the development of a premium assistance program for low-income working families

Return to main MCHbest page >>

Overview. Premium assistance programs are an example of a strategy states can use to ensure children and youth with special health care needs. (CYSHCN) have adequate insurance coverage. In premium assistance programs, an agency pays all for part of a family for child’s health insurance premium. These programs are often implemented for low-income working families who cannot afford the expense of family coverage under an employer-sponsored plan. Premium assistance programs have grown in popularity with the advent of the Children’s Health Insurance Program. (CHIP), in part as a strategy to ensure that low-income families do not drop their employer-sponsored coverage in order to obtain less costly CHIP coverage for their children, and also to help support families to keep working.[1]

Evidence. Expert Opinion. Strategies with this rating are recommended by credible, impartial experts, guidelines, or committee statements; these strategies are consistent with accepted theoretical frameworks and have good potential to work. Often there is literature-based evidence supporting these strategies in related topic areas that indicate this approach would prove effective for this issue. Further research is needed to confirm effects in this topic area.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Boston University's Catalyst Center Financing Strategies Database

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Health Outcomes. This strategy helps contribute to reducing avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of agencies for organizations implementing premium assistance programs for families with limited financial resources and children with special health care needs. (Measures availability of the program)
  • Number of premium assistance applications distributed to potentially eligible families. (Quantifies dissemination of enrollment materials)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of premium assistance applications that are approved for eligible families. (Reflects effectiveness of eligibility determination process)
  • Percent of enrolled families who receive their first premium payment within 30 days of approval. (Measures timeliness of assistance delivery)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of employers engaged as partners to facilitate premium assistance enrollment for eligible employees. (Leverages business community support)
  • Number of family organizations and community groups that provide education on premium assistance. (Expands trusted sources of information and support)

OUTCOME MEASURES:

  • Number of children with special health care needs who gain access to new for expanded benefits through employer-sponsored plans. (Reflects improvement in scope of coverage)
  • Number of families able to increase work hours for income while maintaining coverage due to premium assistance. (Shows positive employment and economic outcomes)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of working families experiencing financial constraints and children with special health care needs in the state who are enrolled in premium assistance. (Measures program reach into the population facing health challenges)
  • Percent of policies and procedures that are reviewed and updated annually to sustain the program. (Assesses continuous quality improvement efforts)

OUTCOME MEASURES:

  • Percent reduction in the percent of working families experiencing economic challenges with children with special health care needs who are uninsured. (Evaluates progress toward comprehensive coverage)
  • Percent of children with special health care needs with premium assistance who rate their health as good, very good for excellent. (Measures overall health and well-being outcome)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs. Premium Assistance Financing Strategy.
https://ciswh.org/project/the-catalyst-center/financing-strategy/premium-assistance/

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.