Administrative Change for High-Risk Subscribers

The Pre-Existing Condition Insurance Plan (PCIP), a federally-funded, state-run interim program, is moving from state to federal oversight for the rest of the year.

A high-risk pool for people unable to secure health care insurance under pre-Affordable Care Act rules, PCIP is temporary because the new federal reform law prohibits insurers from denying coverage based on pre-existing conditions.

Now the “state-run” part of that program is also on its way out, as California will shift control and management of the program to federal officials, according to administrators at the Managed Risk Medical Insurance Board (MRMIB), which currently runs PCIP in California.

“It’s important for subscribers to understand what is happening,” MRMIB executive director Janette Casillas said. “They will be transitioning to a federal program for the last six months of the year.”

Federal officials made the move to cut costs nationally, and make sure all PCIP provider rates are set at Medicare reimbursement levels.

Federal officials ended new enrollment in PCIP starting on Mar. 3. Existing enrollees are still covered, however, and will be till the end of 2013, Casillas said.

“Subscribers will get a notice from us first,” Casillas said. That notification will go out this week. “Then the federal government will be sending them a welcome notice in mid-June. Then CMS will take over providing health care services starting July 1,” she said.

The federal move ensures that California PCIP enrollees will receive services until the changeover in 2014 to Covered California, the state’s health benefit exchange.

California has the largest pool of PCIP subscribers in the nation, about 17,000.

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