Commonwealth releases paper on PCIP

Posted on September 13, 2012 | No Comments

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The Affordable Care Act’s (ACA’s) Pre-Existing Condition Insurance Plan (PCIP) is the temporary, federal high-risk pool which will provide coverage to uninsured individuals with preexisting conditions until 2014, when exchange coverage becomes available. Nearly 78,000 people have enrolled since the program was implemented two years ago. An issue brief recently released by the Commonwealth Fund compares the PCIP with state-based high-risk pools that existed prior to the ACA. The paper discusses the programmatic differences that could have caused the lower-than-anticipated enrollment and higher-than-anticipated costs for the PCIP. PCIP coverage, like state high-risk pool coverage, likely remains unaffordable to most lower-income individuals with preexisting conditions, but provides much needed access to care for those able to afford it. Operational costs of these programs are also quite high, making them less than optimal as a means of broader coverage expansion.

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In an Interim Final Rule released Friday, the Centers for Medicare and Medicaid Services (CMS) stated that as of June 15th, payment rates for the federal Pre-Existing Condition Insurance Plan (PCIP) will be set to those of Medicare. Until the passage of the Affordable Care Act (ACA), many Americans with pre-existing conditions were denied insurance coverage or charged exorbitantly high premiums. PCIP, which was created under the ACA, was allocated $5 billion to enable those with pre-existing conditions to obtain insurance prior to 2014. 135,000 otherwise uninsured individuals with pre-existing conditions were granted coverage under PCIP, with claims averaging $32,108 per enrollee. Changes in PCIP payments were authorized in order to ensure program solvency until 2014. One specific example is the provision in which payments to skilled nursing facilities may be reduced by 50% as of June 15, 2013. Enrollment in federal PCIP programs was capped in February due to funding concerns. Enrollment in the 27 state-operated PCIP programs was suspended several weeks later. As of now, 17 of the state-operated PCIP programs will be administered by the US Department of Health and Human Services (HHS) for the duration of the year. Enrollment in federal PCIP programs was capped in February due to funding concerns. Enrollment in the 27 state-operated PCIP programs was suspended several weeks later. As of now, 17 of the state-operated PCIP programs will be administered by the US Department of Health and Human Services (HHS) for the duration of the year.
The Department of Health and Human Services (HHS) issued an amendment to an interim final rule to prevent young illegal aliens allowed to stay in the United States under President Obama's amnesty program from joining a high-risk insurance pool program. from joining high-risk insurance pool programs. The amendment modifies the 2010 interim final rule which implements the Affordable Care Act's (ACA's) Pre-Existing Condition Insurance Plan (PCIP) program. The purpose of PCIP is to enable people who have been uninsured for at least six months due to medical problems to obtain coverage at the same price as those without pre-existing conditions. PCIP will end in 2014 when plans are barred from charging more to consumers with medical problems. The amendment was released because the 2010 interim final rule held that individuals could enroll in these pools if they were citizens, nationals, or a "lawfully present" in the United States.
The Department of Health and Human Services has published interim final rules on the Pre-Existing Condition Insurance Plan Program.
Department of Health and Human Services spokesperson Jenny Backus has released the following statement clarifying abortion coverage in the Pre-Existing Condition Insurance Plans:
The U.S. Government Accountability Office (GAO) has issued a report comparing the early stages of the federal Pre-Existing Condition Insurance Plan (PCIP) with the Children's Health Insurance Program (CHIP). The federal PCIP was authorized by the Affordable Care Act (ACA), and is intended to provide insurance for individuals with previously existing medical conditions who have been unable to obtain health insurance coverage for at least 6 months. GAO was tasked by the Senate with comparing early enrollment and implementation across both PCIP and CHIP. GAO found that like CHIP, enrollment in PCIP was slow in the beginning, but increased over time. GAO also found that enrollment in PCIP was generally lower in States that had high risk pools than in States that did not. For more information on pre-existing conditions, click here.
The Affordable Care Act appropriated $5 billion to create the Pre-Existing Condition Insurance Plan (PCIP) program, which provides insurance for such individuals until new protections take effect in 2014. 27 states opted to run their own PCIPs, while 23 states and the District of Columbia opted to let the Department of Health and Human Services (HHS) run the PCIPs for their residents. Through their study "Pre-Existing Condition Insurance Plans: Program Features, Early Enrollment and Spending Trends, and Federal Oversight Activities," the U.S. Government Accountability Office (GAO) examined 1) PCIP features, premiums, and criteria for demonstrating a pre-existing condition, 2) trends in PCIP enrollment and spending, including administrative costs, and 3) federal oversight activities. The GAO found that state and federally run PCIPs generally had similar cost sharing arrangements. Coverage limits were common but varied, both in terms of the benefits affected and the extent of the limits. Monthly premiums ranged considerably and were generally higher in the federally run PCIP. Enrollment and spending for state and federally run PCIPs have been significantly lower than initial projections. Spending was also lower than anticipated.
The Commonwealth Fund has released a report analyzing state-to-state variations in the Pre-Existing Condition Insurance Programs established by the health reform law.
Provides funding for a temporary high-risk health insurance pool for individuals with pre-existing conditions.