California Pre-Existing Condition Plan & Mr. MIP
The Affordable Care Act of 2010 set up a temporary high risk pool program aka PCIP to provide health coverage for eligible individuals and Self Employed that do not qualify for AB 1672 Small Group Guaranteed Issue Health Coverage, until December 31, 2013 when the national health reform is set to begin. This program is available for individuals who have not had health coverage in the 6 months prior to applying.
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pcip.ca.gov
Historical Information
2011 PCIP Handbook
Interim Final Rule Pre-Existing Condition Insurance Plan
Federal Regulations & Guidance CMS
TITLE 45--Public Welfare
SUBTITLE A--DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B--REQUIREMENTS RELATING TO HEALTH CARE ACCESS
PART 152--PRE-EXISTING CONDITION INSURANCE PLAN PROGRAM
 Subpart A--GENERAL PROVISIONS
Subpart B--PCIP PROGRAM ADMINISTRATION
Subpart C--ELIGIBILITY AND ENROLLMENT
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| Enrollment and disenrollment process. |
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Subpart D--BENEFITS
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| Prohibitions on pre-existing condition exclusions and waiting periods. |
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| Premiums and cost-sharing. |
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Subpart E--OVERSIGHT
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| Preventing insurer dumping. |
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Subpart F--FUNDING
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| Initial allocation of funds. |
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Subpart G--RELATIONSHIP TO EXISTING LAWS AND PROGRAMS
Subpart H--TRANSITION TO EXCHANGES
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| End of PCIP program coverage. |
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| Transition to the exchanges. |
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Obama's Plan
mr mib.ca.gov/
Fact Sheet - Comparison of MR MIP and Obama's Plan
Info on HealthCare.Gov
Section 1101: ESTABLISHES AN INTERIM HIGH RISK POOL PROGRAM
6/28/2010 Calif Health Line - Status on Pending CA Bills
6/22/2010 Sacramento Bee Article
Provides immediate access to insurance for Americans who are uninsured because of a pre‐existing condition.
Establishes a temporary national high-risk pool to provide health coverage to individuals with pre-existing medical conditions.
- U.S. citizens and legal immigrants who have a pre-existing medical condition and who have been uninsured for at least six months will be eligible to enroll in the high-risk pool and receive subsidized premiums.
- Premiums for the pool will be established for a standard population and may vary by no more than 4 to 1 due to age;
- Maximum cost-sharing will be limited to the current law HSA limit ($5,950/individual and $11,900/family in 2010).
- The law appropriates $5 billion to finance the program.
- The new pools are to be administered directly by a state or a nonprofit entity under contract. States may not reduce their current high risk pool efforts.
Premiums in the new federal pool are expected to be 10 percent to 50 percent lower than current state rates, said Richard Popper, who directs Maryland's program. Co-payments and deductibles are also expected to be considerably lower. But the only way current beneficiaries could get the federal coverage would be to drop out of their state pool and go uninsured for six months.
(Effective within 90 days of enactment: June 21, 2010, until January 1, 2014)1
California AB 1887 by Assm. Villines (R)
Would establish a federally qualified high-risk insurance pool for individuals who are unable to obtain private coverage because of a pre-existing condition.
California already has a high-risk insurance pool that covers about 7,000 residents, but it does not meet requirements to qualify for federal subsidies under the new health reform law. Authorizes the existing MR MIP to apply for any federal funding the board determines to be cost effective for purposes of extending major risk medical coverage. to more applicants.
See also SB 227
http://www.leginfo.ca.gov/bilinfo.html
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