Operational Grants to States for High Risk Pools
The Centers for Medicare & Medicaid Services (CMS) will make grants available from the appropriations authorized under section 2745(d)(1)(B) of the Public Health Service Act (PHS Act) for the costs of operational losses for the operations of qualified high risk pools by States.
The following grant opportunities are available to states operating qualified high-risk pools:
Grants for Operational Losses- States that have established a qualified high risk pool that has incurred losses and (1) restricts premiums charged under the pool to no more than 200 percent of the premium for applicable standard risk rates; (2) offer a choice of two or more coverage options through the pool; and (3) has in effect a mechanism reasonably designed to ensure continued funding of losses incurred by the state in connection with operations of the pool after the end of the last fiscal year for which a grant is provided under this paragraph.
Special Rule for Pools Charging Higher Premiums - In the case of a qualified high-risk pool of a state which charges premiums that exceed 150 percent of the premium for applicable standard risks, the State shall use at least 50 percent of the amount of the grant provided to the state to reduce premiums for enrollees.
Bonus Grants for Supplemental Consumer Benefits - States that have established a qualified high risk pool and are receiving grants for operational losses are eligible to apply for a grant to be used to provide supplemental consumer benefits to enrollees or potential enrollees (or defined subsets of such enrollees or potential enrollees) in qualified high risk pools.
The following grant opportunities are available to states operating qualified high-risk pools:
Grants for Operational Losses- States that have established a qualified high risk pool that has incurred losses and (1) restricts premiums charged under the pool to no more than 200 percent of the premium for applicable standard risk rates; (2) offer a choice of two or more coverage options through the pool; and (3) has in effect a mechanism reasonably designed to ensure continued funding of losses incurred by the state in connection with operations of the pool after the end of the last fiscal year for which a grant is provided under this paragraph.
Special Rule for Pools Charging Higher Premiums - In the case of a qualified high-risk pool of a state which charges premiums that exceed 150 percent of the premium for applicable standard risks, the State shall use at least 50 percent of the amount of the grant provided to the state to reduce premiums for enrollees.
Bonus Grants for Supplemental Consumer Benefits - States that have established a qualified high risk pool and are receiving grants for operational losses are eligible to apply for a grant to be used to provide supplemental consumer benefits to enrollees or potential enrollees (or defined subsets of such enrollees or potential enrollees) in qualified high risk pools.
Related Programs
Grants to States for Operation of Qualified High-Risk Pools
Department of Health and Human Services
Agency: Department of Health and Human Services
Office: Centers for Medicare & Medicaid Services
Estimated Funding: $49,127,000
Office: Centers for Medicare & Medicaid Services
Estimated Funding: $49,127,000
Obtain Full Opportunity Text:
http://www.cms.hhs.gov/highriskpools/
Additional Information of Eligibility:
This is a COMPETITIVE opportunity for State High Risk Pools with an active CMS grant that has been awarded a no-cost extension beyond March 31, 2008, see section below entitled "Competitive Continuation Grants." 1.
Eligibility Criteria A qualified high risk pool as defined in sections 2744(c)(2) and 2745(g) of the PHS Act is a risk pool that (a) provides to all eligible individuals health insurance coverage (or comparable coverage) that does not impose any preexisting condition exclusion with respect to such coverage for all eligible individuals, except that it may provide for enrollment of eligible individuals through an acceptable alternative mechanism (as defined for purposes of section 2744) that includes a high risk pool as a component, and (b) provides for premium rates and covered benefits for such coverage consistent with standards included in the NAIC Model Health Plan for Uninsurable Individuals Act that was in effect at the time of the enactment of the Health Insurance Portability and Accountability Act of 1996 (August 21, 1996).
To be eligible for a grant, a state must have an established qualified high risk pool that has incurred losses and (1) restricts premium charged under the pool to no more than 200 percent of the premium for applicable standard risk rates; (2) offers a choice of two or more coverage options through the pool; and (3) has in effect a mechanism reasonably designed to ensure continued funding of losses incurred by the state in connection with operations of the pool after the end of the last fiscal year for which a grant is provided under this paragraph.
The state must provide sufficient documentation of the losses incurred in the operations of the qualified high risk pool for the covered grant period.
Full Opportunity Web Address:
http://www.cms.hhs.gov/highriskpools/
Contact:
Louise AmburgeyLouise.Amburgey@cms.hhs.gov
Agency Email Description:
Louise Amburgey
Agency Email:
Louise.Amburgey@cms.hhs.gov
Date Posted:
2008-04-04
Application Due Date:
2008-06-09
Archive Date:
2008-07-09
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