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The Commonwealth Fund hosted a webinar on the Affordable Care Act provision on establishing temporary high-risk pools, also called Pre-Existing Condition Insurance Plans (PCIPs). PCIPs are designed to quickly make health insurance available to uninsured individuals with pre-existing conditions, many of whom previously had been denied coverage. PCIPs are a temporary measure until 2014 when the health insurance exchanges begin. Speakers examined eligibility, benefits, premiums and cost-sharing, enrollment and outreach, and oversight of the PCIP programs, as well as plan variability.

The webinar based on The Commonwealth Fund’s new issue brief:  Realizing Health Reform’s Potential: Pre-Existing Condition Insurance Plans Created by the Affordable Care Act of 2010, incorporated presentations from Wisconsin and New Mexico high risk pool officials  as examples of how the new PCIP system is working in various states. Both New Mexico and Wisconsin have the oldest state high risk pools in the country. Wisconsin has been operating their plan since 1980 and New Mexico since 1987. Both states have agreed to administer the PCIP plans and will provide subsidies for premiums to those who qualify.

In the new issue brief The Commonwealth Fund found:

  • 27 states chose to administer their PCIPs
  • 23 states have federally administered PCIPs
  • The federal government gave states flexibility in designing the PCIP resulting in variability in benefits and coverage among the states, for example:
    • Rhode Island requires PCIP enrollees to participate in a care coordination program
    • NY provides annual vision exams to its PCIP enrollees
  • Premiums also vary, for example on the low end Hawaii’s PCIP premiums start at $330.00 and on the high end $556.00 in Florida, with a national average of $455.00

For more information on the webinar visit the Commonwealth Fund’s website.

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