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9 States Seek Help For High-Risk Pools

By Phil Galewitz

January 5th, 2012, 6:21 PM

Nine states have asked the federal government for more money to make sure their new high-risk pools that provide health coverage for people with pre-existing conditions don’t run out of money before 2014, the Obama administration said Thursday

Two of the states — California and New Hampshire  — have already been promised additional money.

The other seven states that have requests pending with the Centers for Medicare and Medicaid Services (CMS) are Alaska, Colorado, Montana, New Mexico, Oregon, South Dakota and Utah.

“We continue to work with states to meet their needs,” said Bennett Blodgett, a CMS spokesman. “We will adjust each state’s yearly allotment as necessary.”

Some of the states looking for help have served relatively few people. Alaska, for example, had 48 people in its pre-existing condition pool as of Oct. 31. It was initially allotted $13 million. Montana had 269 people; it was allotted about $16 million.

Because nationwide enrollment has been far less than expected,  federal funding for the program established under the health overhaul appears plentiful: $5 billion was set aside and less than $500 million has been spent in the first 16 months. The program is scheduled to end in 2014 when insurers can no longer deny people coverage for pre-existing health conditions.

But funding allotments for a few states are beginning to run low, largely because health costs have been higher than expected.

Officials in both California and New Hampshire feared they might start running out of funds by early next year. California, which was allotted $761 million initially, was given an additional $118 million.

New Hampshire, which was allotted $20 million, was given another $30 million. New Hampshire, which has 260 people enrolled in the program, had spent $12 million on the program through September. “The people who enrolled were sicker than anticipated,” said Roland Lamy, assistant director of the New Hampshire Health Plan, a nonprofit group that is administering the high risk pool.

Nearly 42,000 people nationally have signed up for the new Pre-existing Condition Insurance Plans as of Oct. 31 — up from 25,000 in May, according to HHS. The program, which began in June 2009, was initially expected to enroll between 200,000 to 400,000 people. Enrollment has increased since the summer, after premiums fell in some states by as much as 40 percent and some states stepped up advertising. To qualify for the program, people have to be uninsured for at least six months and either have been turned down for coverage by an insurer, or have a doctor’s note certifying they have a chronic health condition.

3 Responses to “9 States Seek Help For High-Risk Pools”

  1. sparky says:

    I can’t for the life of me figure out why they need more money? It is a terrific risk pool – uninsured for at least 6 months and guaranteed to have a chronic health condition. Never saw this coming.

  2. While the PCIP and MRMIP are the only choice many people with pre-existing conditions have to seek medical care, it is again a band-aid on our national health care problem.

    The MRMIP (here in California) insurance program has very expensive monthly premiums and until the new health care law is fully enacted, still has yearly benefit caps. If you have an expensive disease, like Multiple Sclerosis or cancer, then you know that a $75,000 per year cap on benefits is a drop in the bucket when most medications for the disease cost around $4500 per month. The MRMIP at least allows you to pay to cover your dependents. The PCIP (federal program) does not.

    The only sensible fix for this country is Medicare for Everyone; a cradle to grave national system where we can all have the chance to pay into the risk pool and receive affordable coverage.

  3. mandrake says:

    Medicare for all doesn’t have a chance as long as AHIP, the AMA, the AHA and PhRMA control Congress. In Congress, money talks and BS walks!

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