Overlapping Approaches

States often employ coverage strategies that combine tactics in their efforts to expand access to health insurance. The use of overlapping approaches allows states to tackle coverage expansion from more than one direction, tailoring their strategies to the particular needs of different groups (i.e., small employers, low-wage workers, children, childless adults, etc.).

The goal of an overlapping approach is to maximize the inherent strengths of public, employer and market-based coverage initiatives.

The following are examples of overlapping approaches that are currently in place. Please visit our State Policy Summaries page for more information about current state initiatives.

Public/Private Cost-Sharing toward Public Insurance in the Small-Group Market
New Mexico’s State Coverage Insurance (SCI) program is a public/private partnership geared toward uninsured working adults in the small-group market. Employers who have one to 50 employees are eligible to sponsor group enrollment in the SCI plan. Employers pay $75/month, and employees pay up to $35, depending on income. Uninsured workers employed by small businesses can also enroll in the SCI program without employer sponsorship.

Public Subsidies toward ESI Premiums for Small Businesses
The Insure Oklahoma/O-EPIC ESI program is a public-private partnership that provides subsidies for small businesses that offer insurance to their employees. Through Insure Oklahoma, the state pays 60% of the health insurance premiums for employees of small businesses that meet certain income guidelines, while the employer pays 25% and the worker pays 15%. The state receives $2 in federal funds for every dollar invested in the program.

Public/Private Cost-Sharing toward Public Limited Benefit Plans
In 2007, Tennessee passed CoverTN, a limited benefit health insurance plan for the self-employed and small businesses and funded by individuals, employers and the state. The plan is owned by the individual (therefore portable) and the cost containment is based on limits within service categories as opposed to benefit exclusion. This public-private partnership is unique not only because of its financing, but in how benefits are limited.

Medicaid Waiver to Create Trust Fund for Premium Assistance toward Private Coverage
In 2007, Texas created the Health Opportunity Pool trust fund, which incorporates federal funding (through a 1115 waiver), redirected disproportionate share payments, and state revenues to support premium assistance toward private coverage for low-income residents and public cost-sharing of employer-sponsored coverage through three-share programs.

Small Group Access to State Employee Insurance Rates
The West Virginia Small Business Plan allows eligible small businesses access to a Blue Cross/Blue Shield plan using Public Employees Insurance Agency (PEIA) reimbursement rates, which results in lower premiums.

Three-Share Programs
New Mexico’s State Coverage Insurance (SCI) program is a "three-share" public/private partnership, funded by a combination of (1) SCHIP dollars, (2) state funds, and (3) employer and individual premiums. Small employers may sponsor low-income workers (<200% FPL) to enroll in the program, or low-income individuals may enroll in the program directly, without employer sponsorship. Premiums for both employers and individuals are determined on a sliding scale based on the individual enrollee’s income.