Coverage Begins for High-Risk Enrollees

After setting an ambitious timetable for startup and then hitting delays for almost a month after its scheduled launch, the state’s Pre-Existing Condition Insurance Plan officially started enrolling patients yesterday.

The program will use $761 million in federal money to help insure Californians who cannot get health insurance coverage because of pre-existing conditions. So PCIP helps provide coverage to people who would not otherwise get it.

“We’re very happy for the people of California who need this,” Jeanie Esajian of the state’s Managed Risk Medical Insurance Board said yesterday.

“We pushed the button this morning with great delight.”

Under the national health reform law, pre-existing conditions will cease to be an acceptable reason for denying coverage in 2014. Until then, PCIP is a stopgap measure for those patients.

The structure of the federally funded program bears little resemblance to California’s own high-risk pool (the Major Risk Medical Insurance Program, or MRMIP), Esajian said.

“There is no similarity at all,” Esajian said. “It’s completely different than anything we did in the past. In this case, it’s like we’re the health plan.”

In the MRMIP model, the state contracts with two health insurers — Kaiser and Anthem Blue Cross — and the two insurers run the plan. In the PCIP model, Esajian said, “We contract with entities, quite a few entities, and actually do the day-to-day operations. We contract to do claims processing …. pharmacy management, disease management, all of that.”

Esajian said the delay in large part was because this system was so different from previous set-ups.

“It’s a very common model that a lot of big employers use,” Esajian said, “but it’s not something we’ve ever done.”

The system is designed to eventually handle 17,000 to 23,000 patients in California. So far, about 6,000 people have requested applications, and an estimated 610 have filed applications, according to Esajian.

Those enrollment numbers are estimates. Actual enrollment numbers will be released this week, she said.


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