The Affordable Care Act (ACA)
mandated that every state create or maintain a Pre-Existing Condition Insurance Plan (or PCIP), to make health insurance available to people who have had a problem getting insurance due to a pre-existing condition.
The ACA created a number of new opportunities for patients in the US who do not have insurance to obtain it starting in 2014. To help certain patients obtain coverage prior to 2014, the ACA gave states the option to create a state-administered PCIP or allow the federal government to serve those patients through the federally administered PCIP.
28 states chose to develop their own state-run PCIP: Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Illinois, Iowa, Kansas, Maine, Maryland, Michigan, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhodes Island, South Dakota, Utah, Washington, and Wisconsin.
23 states and the District of Columbia opted to have HHS administer a Federally-run PCIP coverage to their constituents: Alabama, Arizona, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Nebraska, 4Nevada, North Dakota, South Carolina, Tennessee, Texas, Vermont, Virginia, West Virginia and Wyoming.
PCIPs are similar in concept, but not the same as a high-risk insurance pool. Both were created to serve “medically uninsurable” patients who have pre-existing health conditions that made obtaining insurance very costly, or impossible.
The PCIPs covered major medical and prescription drug expenses, but enrollees are responsible for paying premiums, deductibles, copayments, and coinsurance amounts.
The PCIPs were temporary, and established provide health coverage to individuals with pre-existing conditions starting in 2010, lasting until 2014.
Starting in 2014, individuals whose employers don’t offer them insurance will be able to buy insurance directly in an Exchange, and the law will prohibit insurance companies from refusing to sell coverage or renew policies because of a person’s pre-existing condition.
On February 16, 2013, the federally-run Pre-Existing Condition Insurance Plan (PCIP) suspended acceptance of new enrollment applications until further notice. The suspension also became effective in the state-based PCIPs on March 2. This was done to ensure that funds would be available to continuously cover people currently enrolled in PCIP through the remainder of 2013.