High-Risk Pools

The Alabama Health Plan became operational in 1998 and as of June 2006, there were just over 3,000 people enrolled. The program is financed by member premiums and assessments to the insurance industry based on premium volume in the state. The program has a premium cap that is 200 percent of market rate for comparable coverage.

In 1993, the legislature of the state of Alaska created the Alaska Comprehensive Health Insurance Association (ACHIA) to provide health insurance to high risk individuals who are unable to find or who are denied health insurance coverage in the private market because of a medical condition and to those individuals who have had prior health insurance coverage and meet the federal rules for eligibility. The premium cap for the program is 150 percent of market rate for comparable coverage. The program is financed through subscribers’ premiums and assessments on insurers. At the end of September 2008, about 500 persons were enrolled in the program.

The Arkansas Comprehensive Health Insurance Pool was created in 1996 as a state program that was intended to provide an alternative market for health insurance for certain uninsurable Arkansas residents and to provide the acceptable alternative mechanism as described in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 for providing portable and accessible individual health insurance for federally eligible individuals. The premium cap for the pool is set at 150 percent of market rate for comparable coverage. At the end of June 2006, approximately 2,900 people were enrolled in the pool.

The California Major Risk Medical Insurance Program (MRMIP) was a program developed to provide health insurance for Californians who are unable to obtain coverage in the individual insurance market. This program became operational in 1991. Subscribers in the MRMIP are charged a monthly premium ranging from 125 to 137.5 percent of each participating plan's average standard individual rate. On May 21, 2008 the enrollment cap was lowered to 7,100 from 8,101. Due to limited state appropriation, MRMIP enrollment is currently closed and there is a waiting list for new enrollments.

Colorado’s high-risk pool, CoverColorado, became operational in 1991. The pool has a premium cap of 150 percent of market rate for similar coverage and is financed by the state’s unclaimed property trust fund, premiums paid by recipients, and a premium tax credit. For recipients who earn less than $50,000 per year, premium subsidies may be available. Premium discounts represent an approximately 20 percent reduction from the standard PPO rate. As of June 2006, just over 5,000 persons were enrolled in the program. 

The Connecticut Health Reinsurance Association has been in operation since 1976 and is financed through premiums and assessments on insurers. The premium cap is 125 percent of market rate for comparable coverage at initial enrollment and 150 percent at maximum. Connecticut charges a lower premium for recipients who have income less than 200 percent FPL. As the end of 2005, more than 2,400 persons were enrolled in the program.

Florida’s high-risk pool, the Florida Comprehensive Health Association has been closed to new enrollment since 1991. There are approximately 400 recipients remaining in the program which was originally established in 1983. The premium cap varies (between 200 percent and 250 percent of market rate for comparable coverage) and enrollees are grouped into one of three risk categories. The program is financed through premiums and assessments on insurers.

The Idaho Individual High-Risk Reinsurance Pool became operational in 2001 and currently has an enrollment of approximately 1,400 individuals. In the nongroup (individual) market, the state operates the Individual High-Risk Reinsurance Pool that reinsures fiveguaranteed issue products and sets premiums for the guaranteed issue products. The primary insurer is responsible for the first $5,000 in claims, 10 percent of the next $25,000. All claims exceeding $25,000 are covered by the reinsurance pool, up to the lifetime maximums of the guaranteed issue products.

The pool is funded through premiums, a portion of the state premium tax, and, if necessary, an assessment on insurers. The premiums for the guaranteed issue products are between 125 percent and 150 percent of the rates applicable to standard risks. The Idaho High-Risk Pool functions differently than most state high-risk pools. Under Idaho’s program, all carriers who offer individual health insurance must also offer the Idaho Individual High-Risk Reinsurance Pool plans, as well as notify persons applying for individual coverage of these high-risk pool plans.

Illinois’ high risk pool, the Illinois Comprehensive Health Insurance Plan (ICHIP), became operational in 1989. Total enrollment in ICHIP was approximately 16,550 as of January, 2007. In 2006, premiums were set between 125 and 150 percent of the average charged for comparable coverage. ICHIP operates two programs:

• The traditional ICHIP covers the medically uninsurable and is funded by premiums paid by participants and state general funds. Enrollment in traditional ICHIP was approximately 5,800 in January of 2007.
• HIPAA-CHIP covers Health Insurance Portability and Accountability Act (HIPAA) and Health Coverage Tax Credit (HCTC) qualified individuals and is funded through member premiums and an assessment on the insurance industry. From 2004 through 2006, federal grant funds helped offset premium.   Premiums are set at 135 percent of the average charges for comparable services. At the beginning of January 2007, approximately 10,750 persons were enrolled in this portion of ICHIP.

Indiana’s high-risk pool, the Indiana Comprehensive Health Insurance Association became operational in 1982 and is financed by assessments on insurers. The premium cap for the program is 150 percent of average commercial rates for individual rates. As of June 2006, just over 7,200 persons were enrolled in the program.

The Health Insurance Plan of Iowa (HIPIOWA) is the high-risk pool that serves residents that cannot purchase coverage in the private market for reasons including: pre-existing medical condition or disease diagnosis that results in a premium higher than HIPIOWA rates, reduced benefits or benefit limitation, or an outright denial. Residents of Iowa are also eligible if they qualify under federal HIPAA or COBRA protections. At the end of 2005, just over 1,300 persons were enrolled.

The Iowa Individual Health Benefit Reinsurance Association (IHBRA), a previously existing pool of reinsured individuals, was merged into HIPIOWA effective January, 2005.

The Kansas Health Insurance Association (KHIA) offers health benefits for residents who are unable to purchase coverage in the private market for a pre-existing condition, who qualify for HIPAA protections or COBRA rights, who have been quoted a rate higher than the KHIA rate, or who have exhausted health coverage.

Kentucky’s high-risk pool, Kentucky Access, became operational in 2001 and is financed by program participant premiums, tobacco settlement funds, and assessments on insurers. The program’s premium cap is set at 175 percent of market rate for comparable coverage but the program currently sets rates at 130 percent. As May 2006, approximately 3,700 persons were enrolled in the program.

The Louisiana Health Plan, Louisiana’s high risk pool and HIPAA pools, became operational in 1992 and is financed through several sources, including state general revenues, the Louisiana mandated service charge, insurer assessments, and policyholder premiums. The premiums range from 125 percent to 200 percent of market rate for comparable coverage. By the end of 2005, just under 1,200 people were enrolled in the program.

Since 2003, Maryland has offered a health insurance program, The Maryland Health Insurance Plan (MHIP), to residents who are considered uninsurable either because they are high risk or have a history of medical problems that makes it difficult for them to find affordable insurance coverage in the individual market. In December 2005, MHIP introduced a special premium subsidy program for low income enrollees. Called MHIP+, the program offers discounted premiums and deductibles to individuals with incomes under 225 percent FPL.

MHIP also serves as the “fallback” option under the federal Health Insurance Portability and Accountability Act’s (HIPAA) guaranteed portability requirement for those individuals transitioning from group to individual coverage. Maryland’s risk pool is funded by assessments on Maryland hospitals’ net patient revenues, a subsidy mechanism that distributes the cost of the risk pool broadly.

Minnesota Comprehensive Health Association (MCHA) was established in 1976 by the Minnesota legislature to offer policies of individual health insurance to Minnesota residents who have been turned down for health insurance by the private market due to pre-existing health conditions. MCHA is sometimes referred to as Minnesota’s “high-risk pool” for health insurance or health insurance of last resort.  By law premiums are set at 101 percent – 125 percent of the weighted average for comparable policies.  The program is funded through member premiums and an annual assessment on all health plans. At the end of 2007, about 28,900 Minnesota residents were insured by MCHA throughout the state.

The Mississippi Comprehensive Health Insurance Risk Pool Association became operational in 1992. The pool is financed by subscriber premiums and an assessment to insurers.  The premium cap is set at 150 percent of comparable coverage in the private market at initial enrollment with a maximum of 175 percent of private coverage. At the end of 2005, just over 4,300 persons were enrolled in the program.

The Missouri Health Insurance Pool (MHIP) was established by and operates according to legislation enacted in 1991. Although the MHIP is not an insurance company, it is supervised by the Missouri Department of Insurance. The MHIP is funded by premiums paid by its enrollees and assessments paid by health insurers and HMOs that issue coverage to Missouri residents. There is no limit on the number of individuals who may be enrolled in the MHIP.

The MHIP offers individual coverage through four major medical plans which differ only in the amount of the annual deductible and out-of-pocket maximums. Deductibles range from $500 to $5,000; out-of-pocket maximums range from $2,500 to $5,000. The maximum benefit payable on behalf of any individual during his or her lifetime under any plan or combination of plans the MHIP offers is $1,000,000 for all injuries and illnesses combined. At the end of 2005, approximately 2,800 persons were enrolled in the pool.

In 1987, the Montana Comprehensive Health Insurance Association (MCHA) began operation.  The pool operates a traditional high-risk pool for Montana residents who received rejection from health plans for health coverage, have a qualifying medical condition, or received a restrictive rider or pre-existing condition exclusion.  The Montana Comprehensive Health Insurance Association also serves as a HIPAA alternative mechanism that guarantees coverage for individuals who lose access to group coverage and provides coverage for specific federally eligible individuals.

MCHA operates a premium assistance pilot program designed to assist low-income individuals with purchasing coverage.  The program, funded with a federal grant, reduces the preexisting condition waiting period to four months (if applicable) and subsidizes premiums 45 percent.  MCHA enrollment as of June 2006 was approximately 3,200.

The Nebraska Comprehensive Health Insurance Pool became operational in 1986.  The premium cap for the program is set at 135 percent of average standard health insurance rates. Premium charges for children are set at 50 percent of the standard rate. At the end of May 2007, just over 5,000 persons were enrolled in the pool.

The New Hampshire High-Risk Insurance Pool became operational in 2002. The pool is financed through participant premiums, as well as assessments of insurance plans based on a "per covered lives" basis. Premium caps for the pool are not less than 125 percent and not higher than 150 percent of the standard risk rate for comparable coverage. At the end of 2005, just over 630 persons were enrolled in the pool.

The New Mexico Medical Insurance Pool  became operational in 1988 and is financed by premiums and assessments to insurers. High-risk individuals previously rejected by commercial carriers, those having received a rate increase or rate quote exceeding certain limits based on health status, those who have specific pre-existing conditions, or who have received notice of a rider, waiver, or restrictive provision are eligible to participate. The premium cap is set at 140 percent of the standard risk rate.  New Mexico operates a 75 percent premium subsidy for recipients who earn between 0 percent and 200 percent FPL and a 50 percent premium reduction for recipients between 200 percent FPL and 399 percent FPL.  The subsidy program is called the Low Income Premium Program (LIPP).  At the end of January 2008, over 5,000 persons were enrolled in the Pool.

The Oklahoma Health Insurance High Risk Pool became operational in 1996. The pool is financed by premiums and assessments to the insurers. The premium cap is set at 150 percent of the average premium rate charged. As of June 2006, 2,600 persons were enrolled in the pool.

The Oregon Medical Insurance Pool became operational in 1990 and is financed by premiums and assessments on insurers and reinsurers. The premium cap is set at 125 percent of average rates for individual coverage but portability premiums cannot be more than 100 percent of average portability rate charged by insurers. As of March 2008, approximately 18,500 people were enrolled in the pool.

The South Carolina Health Insurance Pool became operational in 1990 and is financed by premiums and assessments on insurers. The premium cap is set at 200 percent for comparable coverage on the market.   At the end of the 2005, just over 2,200 persons were enrolled in the program.

The South Dakota Risk Pool was created in 2003 to provide coverage to people who have lost coverage and have previous creditable coverage. However, unlike most high-risk pools, the program does not serve uninsured individuals who have a pre-existing condition or illness that causes them to be declined by private insurers unless the person recently lost creditable coverage.  The program is financed by a combination of premiums paid by individual members, state general revenue, assessments on health insurance carriers, and an initial start-up grant from CMS’ risk pool grant program. The premium cap is set at 150 percent of the average in force premium or payment rate for that classification charged by the three carriers with the largest number of individual health plan benefit plans in the state during the preceding calendar year. As of January 2008, 675 persons were enrolled in the pool.

In 2006, SB 200 expanded the eligibility of the Risk Pool to include individuals who are covered by a plan which is no longer being marketed in South Dakota and whose premiums are 200% of what their applicable Risk Pool rate would be. Fifty eight (58) persons have been enrolled based on this expansion. These persons are included in the total enrollment of 675 (January 2008).

The Texas Health Insurance Risk Pool became operational in 1998. The pool is financed by premiums paid by enrollees and assessments on insurers. The premium cap is 200 percent of the average standard rate for commercial health insurance. The board of directors sets the rates annually; currently they are at the maximum of 200 percent.  At the end of February 2008, over 27,500 people were enrolled in the pool.

In 1991, the state established the Utah Comprehensive Health Insurance Pool (HIPUtah), as a state-subsidized high risk pool.  The program specifically address’ the problem of people with serious medical conditions, such as cancer, diabetes, heart disease, and other chronic illnesses, that made them medically uninsurable and, as a result, unable to obtain medical insurance at any price.  As of March 2008, just over 3,500 people were enrolled.  This program is administered privately by SelectHealth.

The Washington State Health Insurance Pool first became operational in 1988. The pool is financed through premiums and assessments to insurers. The premium cap is 150 percent of the standard risk rate in general but 125 percent for the Pool’s preferred provider plan. At the end of 2006, approximately 3100 persons were enrolled in the program.

The West Virginia high-risk pool, known as AccessWV, became operational in 2005. The program is financed through premiums and an assessment on hospitals. The premium cap is not less than 125 percent of the standard individual risk rates for comparable coverage, but shall not exceed 150 percent.   At the end of June 2006, over 200 individuals were receiving coverage through the pool.

Wisconsin’s high-risk pool, the Wisconsin Health Insurance Risk Sharing Plan (HIRSP) became operational in 1981 and provides a choice of three benefit coverage options.  The pool is financed through policyholder premiums, assessments on insurers, and provider discounts.  Premium subsidies are available for qualified low income policyholders. The premium cap is set at 200 percent of the rate that a standard risk would be charged under a policy providing the same coverage deductible.  At the beginning of 2008, almost 17,000 persons were enrolled in the program.   About 2,800 of them received premium subsidies.

The Wyoming Health Insurance Pool became operational in 1991. The pool is funded by assessments on all insurers writing health insurance business in the state plus any self-insured plans not governed by ERISA.  The 2007 legislature created two levels of enrollment, based on the income of the member.  Level 1 applies to all members with an income above 250 percent of the FPL and Level 2 is for those with incomes below that mark.  For Level 1 enrollees, premiums can range between 150 and 200 percent of average premiums and for those in Level 2, the range is 100 to 135 percent.   As of December 2007, just over 650 persons were enrolled in the pool.