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Update on PCIP Enrollment

The most recent reporting on Pre-Existing Condition Insurance Plan (PCIP) enrollment shows that 1,352 Californians have successfully enrolled (24,100 capacity) and 12,437 have enrolled nationwide (375,000 capacity). PCIP is a temporary health plan for the high-risk, medically uninsurable. This low enrollment contradicts initial eligibility estimates, which found that as many as 40,000 people in California (PWC) and 6M in the U.S. (Commonwealth Fund) might be eligible for high-risk pools.

$5B was allotted for high-risk pools nationwide ($761M for California). Because of the high initial estimates of potential eligibles and the high cost of care, the law instituted rules that would limit eligibility, which included a 6-month uninsurance requirement. This means that individuals enrolled in higher cost plans could not enroll in PCIP.

The initial estimates failed to take into account whether or not these “potentially eligible” individuals could afford the premiums offered by PCIP. The premiums in California, which are set at 100% of the premiums of a commercial plan for healthy individuals, are $415/month on average and can be as low as $140/month for someone under 15 and as high as $1,003/month for a near elderly person. In addition, the 6-month uninsurance requirement is an obstacle for high-risk individuals who are currently enrolled in a plan, whether it is a commercial plan or another high-risk plan (such as MRMIP).

Despite a slow start due to delays in enacting the program and finding a contacted PPO network, outreach and education in California have been aggressive. The law mandates that a commercial plan inform an individual of available high-risk plans if they are denied coverage. Insurance agents and brokers who successfully enroll an applicant into PCIP receive a $50 reimbursement. MRMIB has also utilized social media, such as Facebook. Outreach materials are available on the PCIP website.

MRMIB is working with the Department of Insurance to offer continuing education (CE) credit to agents and brokers who view the online PCIP webinar, “PCIP 101.” The federal government turned the state down for premium assistance to lower monthly costs to subscribers.

In order to increase enrollment, congress might consider offering premium assistance and/or lifting the 6-month uninsurance requirement.

Click here to see the California PCIP enrollment summary by county, ethnicity, gender and age.

Click here to see PCIP enrollment by state.

Click here to see MRMIB’s PCIP outreach activities.