GOVERNMENTStates offered money for high-risk insurance poolsStates with existing programs see good and bad in criteria required to get extra federal funding.By Joel B. Finkelstein, amednews staff. Dec. 16, 2002. Washington -- Twenty-seven states and the District of Columbia have the opportunity to grab a piece of $20 million in funding to help start high-risk pools for patients who cannot otherwise get health insurance. State high-risk pools offer coverage to chronically ill patients who can't obtain health insurance in the marketplace. Because these individuals' health costs are so high, the pools are money-losing programs that must supplement premium revenues with taxes and other sources. As mandated by the Trade Act of 2002, the Centers for Medicare & Medicaid Services is offering up to $1 million dollars to states without a high-risk pool or with "unqualified" high-risk pools. CMS will also soon be doling out $80 million to states that are already running qualified pools. To be qualified under Dept. of Health and Human Services rules, high-risk pools must offer insurance to all residents guaranteed coverage under the Health Insurance Portability and Accountability Act of 1996. The law generally aims to protect people from losing health insurance access when they lose or switch jobs. HIPAA allows states to decide how to ensure access to people moving from the group market to the individual market. They could use the high-risk pools or require insurers to sell at least the two most popular policies or two policies representing low-level and high-level coverage. Thirty states have high-risk pools, and 23 of those are qualified programs, as defined by HHS. The seven states with unqualified pools can apply for seed money to modify their program or to start a new pool without altering the existing program.
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Copyright 2002 American Medical Association. All rights reserved.
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