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State High-Risk Pool Directors Weigh Extension of Expiring Programs

By Rebecca Adams, CQ HealthBeat Associate Editor

November 12, 2013 -- Some state officials across the nation are exploring the idea of extending coverage programs for the chronically ill beyond Dec. 31 because they worry that patients will not be able to enroll in the new marketplace benefits in time to have insurance on Jan. 1.

States have run high-risk pools for decades for ill patients who did not have other coverage options. Fifteen of the 35 state programs were slated to cancel coverage by Jan. 1 because state officials assumed people would transfer to the new marketplaces where insurers will be unable to deny coverage for people with pre-existing conditions, according to the National Association of State Comprehensive Health Insurance Plans. Another two states, Colorado and Florida, planned to end coverage in April and June 2014 respectively.

But the troubled launch and technical problems with the health law (PL 111-148, PL 111-152) marketplaces are making some states to rethink whether to cancel the risk-pool coverage. The people who are in the programs are typically quite ill and do not want to disrupt their medical treatments.

“State pools that are closing are going to more seriously consider extending them,” said Oklahoma Temporary High Risk Pool Executive Director, who also chairs the National Association of State Comprehensive Health Insurance Plans. “However, I think there are some state pools that are in states that have taken legislative action that will be difficult to amend at this time” to allow the programs can continue.

Nationwide, about 200,000 people are in the state risk pools. It’s not clear how many are in states that are terminating the programs.

A separate high-risk pool program that was funded by the federal government, known as the Pre-Existing Condition Insurance Plan, is also scheduled to stop at the end of the year. A Centers for Medicare and Medicaid Services (CMS) spokeswoman recently confirmed that there is no way for that program to continue into 2014 without congressional action. About 100,000 people get their coverage through that program.

The patients who have received treatment for serious conditions such as cancer through these programs would be among the most motivated Americans to try to sign up for new marketplace benefits. But technical problems with, the federal marketplace website that handles enrollment for people in 36 states, have prevented many from making it all the way through the enrollment process.

The Obama administration says the exchange website will run smoothly for the “vast majority” of people by Nov. 30. People must sign up and pay premiums by Dec. 15 if they want coverage to begin in January.

Obama administration officials say patients have time. They note that people can call a toll-free number to enroll or get help through in-person assistance so that they can enroll now.

But patients’ groups say they fear people who are extremely ill may have tried unsuccessfully to use the website and may not know of other options. The worry is that patients may be distracted or incapacitated by their treatment and not make the deadline.

“The big issue is: Will people really be able to be signed up?” said Kansas Insurance Commissioner Sandy Praeger, who supports the intent of the health care law and holds the job once held by Health and Human Services Secretary Kathleen Sebelius. “I wasn’t comforted when I heard the website would be functioning by the end of November. That gives people two weeks. We’re gonna have another crash of the system if everyone who wants to get on tries to do it then.”

Praeger said that in Kansas, officials stopped accepting new enrollees into the high-risk program this summer. She plans to try to keep paying for the services of people who are enrolled until they can switch to new coverage, even if that is past the end of the year, when the benefits are supposed to stop.

“We’ll pay those services until there’s a viable option,” said Praeger, calling it a “humanitarian issue.” But she added, “We’ll see whether the legislature will let us. They would the authority to tell us to stop doing that.”

States Beginning to Act

Indiana was the first state to announce on Oct. 31 that it would keep its state-run benefit program going for an additional month through Jan. 31, 2014, because of the uncertainty about enrollment in the marketplaces. State officials are currently trying to decide by Thanksgiving whether they should keep it going longer, said Indiana Department of Insurance chief deputy commissioner Logan Harrison in a phone interview.

“We’ll continue to monitor the status of the federal web portal and determine if the program needs to be continued and continue to make adjustments so people have continuity of coverage,” said Harrison. “They’re very, very ill—these are people with HIV and cancer and other conditions. It could mean a matter of life and death if they don’t have a smooth transition to the marketplace that the federal government has failed to deliver.” The cost of caring for the 6,800 Indiana residents who are still in the program is $6.3 million per month.

In nearby Wisconsin, it is clear that state officials have been repeatedly asked by patients about whether the high-risk pool program—known as the Health Insurance Risk-Sharing Plan, or HIRSP—could continue beyond the end of the year. The first thing that a caller hears when dialing the program is an automated message: “Although the Wisconsin health insurance marketplace is experiencing technical difficulties, there are no current plans to extend HIRSP coverage beyond Dec. 31 2013. Extending HIRSP coverage beyond this date would require a law change. If anything changes regard the final date of coverage for HIRSP members, HIRSP will notify all members as soon as possible.”

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