New Federal Pool

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New Temporary Federal High Risk Pool Program

The federal Patient Protection and Affordable Care Act, signed in March 2010 by President Barack Obama, provides a total of $5 billion for a new, temporary national high risk pool program. This is intended as a stop-gap measure to make health insurance available to uninsured individuals prior to the time that market reforms take effect in 2014.

The new law allocates $81 million for Missouri's new high risk pool, which is being operated by MHIP. This new pool will be separate from Missouri's existing high risk pool which has been operated by MHIP since 1991.

The Secretary of Health and Human Services has the option of implementing the national high risk pool program by entering into agreements for the administration of the program with existing state high risk pools.
Over the past 8 months, the National Association of Comprehensive Health Insurance Plans, the organization of 35 existing state high risk pools, has briefed the Obama Administration and advised Congressional Leadership that most state risk pools are ready and eager to serve as the mechanism to implement the new Federal high risk pool.
Nationally, 35 state risk pools currently insure over 200,000 individuals, by providing comprehensive health insurance coverage.
Risk pools, which nationally provide $2 billion in comprehensive health coverage to high risk individuals, currently only receive $55 million a year in federal funding. The remaining cost to currently insure high risk individuals comes from member premiums, and subsidies authorized by states, such as insurance premium and hospital assessments.
To be eligible for the new federal high risk pool program, an individual must have a preexisting health condition, be a U.S. citizen, and have been uninsured for 6 months.
To be covered under the federal high risk pool program, qualified individuals will pay a premium that is similar to what individuals, who do not have high risk conditions, would pay in the standard insurance market.
Those eligible for the federal high risk pool program will not be subject to a preexisting condition exclusion. Members of the new federal risk pool will pay copays, coinsurance and deductibles no more that 35 percent of the cost of covered benefits.
Those who are not eligible for the new federal high risk pool program can still enroll among the existing 35 state high risk pools.

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