In recent years, several states have developed initiatives to expand Medicaid to low-income adults. The newest expansion strategy available to states is the Health Insurance Flexibility and Accountability (HIFA) Demonstration Initiative, which the United States Department of Health and Human Services (DHHS) introduced in 2001. This innovative initiative aims to encourage states to develop new approaches to increase the number of individuals with health insurance under 200 percent of the federal poverty level (FPL) through the use of the specialized Section 1115 HIFA waivers.
In Texas, 47 percent of non-elderly adults (ages 19-64) with incomes below 200 percent of the FPL are uninsured. Options are available in federal Medicaid statute to help the state address the health care needs of this population. This report describes how a Section 1931 state plan amendment can be developed to insure low-income parents and used to leverage funds to create a budget neutral Section 1115 waiver to extend coverage low-income childless adults in Texas. A model for a HIFA waiver detailing the cost of expansion is presented.