Emilia Ford became pregnant at 15 and, after her daughter was born, dropped out of high school.
As she held down different jobs during the past decade — including housekeeping and working in a relative's retail store — she always thought about going for her GED to show she met high school academic skills.
But the Brookhaven, Pennsylvania, woman needed assistance finding tutors and paying for the set of four tests, which cost $20 each.
She found help from an unexpected source: her Medicaid health plan.
AmeriHealth Caritas, a Philadelphia-based insurer with 2 million Medicaid members in Pennsylvania and five other states, helps connect members with nonprofit groups providing GED test preparation classes, offers telephone coaching to keep members on track and pays the testing fees.
Ford is one of 62 plan members who have earned a GED certificate since the benefit began in 2013.
"I could not believe this was something a health insurance company would do," said Ford, 25. "I thought health insurers only paid for medical costs."
Medicaid health plans are starting to pay for non-traditional services such as meals, transportation, housing and other forms of assistance to improve members' health and reduce medical costs.
That change follows efforts by state Medicaid programs to give health plans financial incentives to control spending, said Jill Rosenthal, senior program director for the National Academy for State Health Policy.
Rather than continue to pay a set fee each month to cover members' health costs, many states are implementing policies that let health plans share in any savings they can demonstrate. That provides motivation for insurers to address factors such as literacy and poor housing, which can drive up health costs.
"Health plans now have incentives for them to find the root causes of problems that will reduce costs that will benefit the plan, its beneficiaries and the states," Rosenthal said.
AmeriHealth Caritas CEO Paul Tufano said studies show people with lower educational levels tend to be in poorer health. "Helping members attain their GED can be incredibly consequential for them to live the kind of life they want to live," he said.
But Tufano acknowledged that only a small fraction of people who need the assistance reach out for it. About 1,000 members have started GED training through the insurer in Pennsylvania, Louisiana, South Carolina and Delaware.
"Many of our members are just surviving to keep their heads over water, holding on to jobs and dealing with issues like safe housing, access to food and transportation to get to work or doctor," he said.
AmeriHealth Caritas is one of just a handful of Medicaid health plans that offer a GED benefit.
WellCare, which covers 2.2 million Medicaid recipients in Missouri, Nebraska, Georgia, Kentucky, Hawaii and Illinois, had 226 members sit for their GED exams since the plan began paying for it in 2012, said spokeswoman Alissa Lawver. The Tampa-based plan does not know how many passed.
A Wellcare survey of its Medicaid adult members in Georgia in 2012 found that about 20 percent did not have a high school diploma or a GED.
"There is a significant relationship between education and health," Wendy Morriarty, president of WellCare's 'Ohana Health Plan in Hawaii, said when launching the benefit in 2016. "A GED is a tool that can lead to increased opportunities for our members to attend college, seek higher-paying jobs and find stable housing. This benefit has the ability to improve the health and well-being of local families and communities."