Deadline Set to End Federal High-Risk Pool

Managed Risk Medical Insurance Board officials yesterday outlined plans to deal with the federal announcement that the Pre-existing Condition Insurance Plan will not accept new applicants after March 2.

The federal PCIP program will continue to provide coverage for enrollees through the end of the year. The program will no longer be needed in 2014 when the Affordable Care Act provision that insurers may not deny coverage because of pre-existing conditions takes effect.

Janette Casillas, executive director of MRMIB, which runs the federally funded plan, said some prospective enrollees could apply for a similar, state-funded program called the Major Risk Medical Insurance Program.

But there’s money only for a limited number of Californians, she said.

“We still have our major-risk insurance program,” Casillas said, “although we do have a benefit cap there.”

Casillas said there is an enrollment cap of 7,000 beneficiaries in the state high-risk program. Right now, there are 5,737 people enrolled in that program, she said, and that doesn’t leave a lot of room to add new applicants.

But it’s something, Casillas said.

“It could fill up quickly, that’s true,” she said. “What happens then is, we would establish a waiting list, as we’ve done before with MRMIP.”

Last month, 877 Californians applied for federal coverage. Assuming the stream of PCIP applicants remains constant and those people apply for and are admitted to MRMIP, the state program could fill up within two months.

The question then will be: How will new applicants with pre-existing conditions get health insurance during the last six or seven months of 2013? 

They likely won’t, Casillas said.

“Individuals will seek care in community clinics, but basically those people are all looking at out-of-pocket fee-for-service,” Casillas said.

For Californians with high-risk conditions, that could be a lot of out-of-pocket money, Casillas said.

“We thought this could happen, and it has,” Casillas said. “All I can say is, the federal government has decided now is the time.”

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