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PCIP Enrollment To Be Capped?

Unless more federal funding is allocated for the Pre-Existing Condition Insurance Plan (PCIP), enrollment may have to be soon capped. PCIP, a federally funded coverage program for individuals who have been denied coverage due to pre-existing conditions, was expected to accommodate up to 23,000 California enrollees. This figure, however, is looking exceptionally optimistic, as enrollment may soon be capped to almost a fourth. The 23,000 estimate was reduced to 6,800 Californians after the first-year claims data showed that enrollees required more funding than initially expected; unlike the state-financed pre-existing condition plan (MRMIP), PCIP does not have annual/lifetime caps and can lead to higher claims. Cliff Allenby, Chair of the Managed Risk Medical Insurance Board (MRMIB) which administers both programs, said, “The annual cap is not there in PCIP, and apparently that makes a big difference.”

Currently enrollment stands at 5,290, which includes 726 new subscribers last month. Unless the federal government provides more funding, current enrollment cap estimates would only allow for only 1,500 more subscribers.