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November/December 2013 St@teside

States Grapple with High-Risk Pool Closures

Before the Affordable Care Act (ACA) was enacted, many states had established high-risk pools to provide coverage for those who had been deemed uninsurable, primarily due to preexisting conditions. With the enactment of the ACA, starting January 1, 2014, insurance companies can no longer deny individuals coverage due to preexisting conditions. Additionally, the establishment of the new health insurance marketplaces provides these previously uninsurable individuals with new coverage options.

In spite of the new coverage options and consumer protections under the ACA, some states will be maintaining their high-risk pools indefinitely and others have plans to revisit their high-risk pools in upcoming legislative sessions. However, 15 of the 35 states with high-risk pools have been planning to close their high-risk pools in January 2014. With the difficult rollout of the new marketplaces, particularly the federally-facilitated marketplace, state officials in those 15 states are now concerned that their high-risk pool enrollees will not be able to sign up through the marketplace in time for their new coverage to begin on January 1, and some are now considering extending their high-risk pools.

The states who have decided to extend their high-risk pools include:

  • Indiana, which has extended coverage for its high-risk pool until February 1, 2014;
  • New Hampshire, which has decided to delay the closure of its high-risk pool, but the cancellation date has not been set; and
  • Texas, which has extended its high-risk pool until March 31, 2014.

Additional states are still weighing their options and developing mitigation strategies. Wisconsin will be holding a special legislative session to decide whether they will extend their high-risk pool coverage beyond December 31, 2013. Oregon’s high risk pool is still slated to close on January 1, but they are currently developing a contingency plan to help ensure that their current high-risk pool enrollees do not experience gaps in coverage. Oregon is currently bolstering their outreach efforts and expediting the high-risk pool enrollees’ applications through the marketplace. Minnesota’s high-risk pool, Minnesota Comprehensive Health Association (MCHA), has already developed a robust transition plan for its enrollees based on this enrollee survey. The enrollee survey provides detailed information on the MCHA population and identifies methods and metrics that other states can use to research their high-risk pool population characteristics.

For more information on states’ high-risk pools and their extension decisions, visit the National Association of State Comprehensive Health Insurance Plans’ website.