Skip to content

Feds To States: Set Up Health Insurance Pools For High-Risk Patients By July 1

Federal officials, eager to launch one of the signature programs of the new health law, have told states that they must provide more information by the end of next week on how they intend to run the high-risk health insurance pools.

The program is designed to provide health insurance to people who have been denied coverage due to a pre-existing medical condition and have been without coverage for at least six months. It will start enrollment on July 1 and begin coverage on Aug. 1, according to guidance that Jay Angoff, director of the Department of Health and Human Service’s Office of Consumer Information and Insurance Oversight, sent to state officials last week. The high-risk pools are intended to offer coverage until subsidies and new health insurance exchanges begin in 2014. 

The high-risk pools are one of a handful of early benefits the administration is promoting, such as provisions that allow some people up to age 26 to stay on their families’ insurance plans, ban insurers from excluding children because of preexisting conditions, and put an end to lifetime limits on health costs insurers impose on some policyholders.

Twenty-nine states and the District of Columbia volunteered to run their own pools and will get a share of the $5 billion funding in the health bill designated to fund them. Nineteen states said they would leave that task to the federal government, with some arguing that the federal funding may dry up and leave them on the hook. HHS says it will ensure that the funds will last for the duration of the program in states where it will administer the pools. But a recent report by the nonpartisan National Institute for Health Care Reform, a think tank funded by automakers and the United Auto Workers, suggested that the $5 billion would be insufficient to cover the number of people who may qualify for the coverage.

In his letter, Angoff assured state officials who may be worried about funding the start-up costs of high-risk pools that any expenses incurred, such as costs of developing or modifying accounting or enrollment systems would be covered by the federal government. The contracts HHS has asked states to submit by June 25 will include details on how they would run the high-risk pools and how much they would cost, among other items.

In remarks Wednesday to the American Nurses Association President Barack Obama urged states running high-risk pools to enroll people as soon as possible. The pools, Obama said, would “ensure that folks who have been shut out of the market because they’ve been sick can access more affordable insurance starting right away.”

KHN’s Christopher Weaver contributed to this report.

This is one of KHN’s “Short Takes” – brief items in the news. For the latest news from KHN, check out our News Section.


Related Topics

Insurance States The Health Law Uninsured