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Pre-Existing Condition Insurance Plan Changes Announced

The Pre-Existing Condition Insurance Plan (PCIP) is a federally funded, temporary high-risk pool created by the Affordable Care Act (ACA) that will end on January 1, 2014.  Some states have run their own PCIP programs and others have been run by the federal government. This program is distinctly different from state high-risk pools that existed before the ACA. 


Because the funding for the PCIP is capped, HHS is concerned about running out of money before the plans are set to end.  As a result, it has instituted a new change to the program. HHS told states that they would get a capped amount of money for claims for the rest of the year.  Before CMS proposed these new terms, the federal government ran the program in 23 states and DC, and 27 states ran their own.  Due to the new policy, however, several states are relinquishing control of their PCIPs to the federal government starting June 1st, 2013. We believe that the only states that will continue to operate their own PCIPs are: AK, CT, MD, ME, MT, NJ, OK, RI and WI.


NHF is concerned about how these policy changes will affect the bleeding disorders community and has contacted HHS to get more information.  PCIP enrollees may have to get new authorizations or face new deductibles if their plan changes, or may have to change pharmacy providers for clotting factor to be covered. 


If you are enrolled in a PCIP that is transitioning to federal control and have any difficulties accessing services at your HTC or obtaining clotting factor, please contact the NHF public policy team.

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