Federal Regulatory Guidance and Actions: Pre-Existing Condition Insurance Plan

NCSL Resources

CAD flagThis is one in a series of NCSL documents offering assistance to states in interpreting and implementing the Affordable Care Act.

Pre-Existing Condition Insurance Plan

Title I, Subtitle B, Section 1101 of the Patient Protection and Affordable Care Act

Directs the Department of Health and Human Services (HHS) to establish a temporary high-risk health insurance pool program within 90 days of enactment, June 21, 2010, to provide health Insurance coverage to eligible individuals through grants.


Guidance/Information - Health and Human Services (HHS)

August 19, 2010

Congressional Research Service Report: Temporary Federal High Risk Health Insurance Pool Program

July 30, 2010

The Department of Health and Human Services released Interim Final Rules for the operation of the Pre-existing Condition Plans in the Federal Register. The rule is effective July 30 but they are accepting comments on the language until September 28, 2010.

July 1, 2010

The new Pre-Existing Condition Insurance Plan was officially launched July 1st by the Department of Health and Human Services (HHS). States that have chosen to operate their own plan include: Alaska, Arkansas, California, Colorado, Connecticut, District of Columbia, Illinois, Iowa, Kansas, Maine, Maryland, Michigan, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Washington, West Virginia, and Wisconsin. To search for information on your state program go to HealthCare.gov.

May 3, 2010: HHS Update

April 2, 2010: Department of Health and Human Services (HHS) Secretary Kathleen Sebelius sent letters to governors and independent insurance commissioners attempting to gather information on the number of states that would be interested in participating in the temporary high-risk pool program established by the new health insurance reform law. States have been given the option to participate in the program, which will provide coverage to the uninsured with pre-existing conditions. The new health insurance reform law provides $5 billion in federal funds to support this new program. In the letter she outlined the number of options for states concerning their participation in the temporary high-risk pool program, which include:

  • Operate a new high-risk pool alongside a current state high risk pool.
  • Establish a new high-risk pool (in a state that does not currently have a high risk pool).
  • Build upon other existing coverage programs designed to cover high-risk individuals.
  • Contract with a current HIPAA carrier of last resort or other carrier, to provide subsidized coverage for the eligible population.
  • Do nothing, in which case HHS would carry out a coverage program in the state.

Press Release--Letter

HHS Fact Sheet -Temporary High Risk Pool Program