HHS Lacks Authority To Adjust Rule on High-Risk Health Plan Enrollment
HHS does not have the power to waive a requirement that individuals who enroll in the high-risk health insurance pools created under the federal health reform law must have been uninsured for six months, an HHS spokesperson said last week, CQ HealthBeat reports.
Details of the Provision
Under the law, state officials can choose to set up their own pool to provide insurance to individuals with pre-existing conditions.
Individuals participating in the pools also must have been without insurance for six months, a requirement that some state officials say limits the number of people who are eligible for the program and prevents those who need the coverage most from obtaining it.
On Sept. 30, Connecticut Gov. Jodi Rell (R) asked HHS Secretary Kathleen Sebelius to waive the six-month requirement, calling it a "stone wall in the form of the absolute, no-exception waiting period required under current federal rules."
Barriers to Adjustment
However, the reform law includes "certain fundamental eligibility requirements with respect to which HHS does not have flexibility and for which there is no waiver authority," including the six-month waiting period, HHS spokesperson Jessica Santillo said.
Santillo added that the reform law allows states more discretion on other issues if they choose to run their own high-risk pools (Adams, CQ HealthBeat, 10/8).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.