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PCIP: California risk pool doubles enrollment

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The California Pre-Existing Condition Insurance Plan (PCIP) has doubled in size in the past year.

The state’s Managed Risk Medical Insurance Board (MRMIB) has reported on PCIP program performance in documents posted in connection with a recent board meeting.

The California PCIP program had 13,565 enrollees in mid-September, up from 4,667 a year earlier.

The latest utilization summary showed that the enrollees had 1,692 inpatient hospital admissions during the second quarter, with an average length of stay of 6.3 days.

The enrollees used outpatient services 18,854 times during the quarter.

The most common diagnosis by plan payment is for patients who are getting chemotherapy, the second most common is for patients who are getting immunotherapy, and the third most common is for patients who contend with morbid obesity.

The most common procedure, by plan payment, is injections with a substance that helps increase white blood cell counts, and the second most common procedure is radiation treatment. Office visits for an established patient rank just fifth on the list.

When morbid obesity appears on the top diagnosis list, “it mostly appears in relation to a single, high-cost claim subscriber,” according to the meeting minutes. 

PCIP nuts and bolts 

If the Patient Protection and Affordable Care Act of 2010 (PPACA) takes effect on schedule and works as drafters expect, it will require insurers to start selling subsidized coverage on a guaranteed issue, mostly community-rated basis in 2014.

Congress added the PCIP program to PPACA in an effort to provide immediate relief for uninsured people with health problems.

PCIP is supposed to provide comprehensive health coverage for people with health problems for a price similar to the price of ordinary individual commercial health coverage.

Eligibility is not based on income, and the risk pools cannot charge higher rates for people with more severe health problems.

Congress let states choose between running PCIP risk pools themselves or letting HHS provide PCIP risk pool services for their residents.

To avoid crowding out existing commercial health coverage and government-provided coverage, including existing state-funded risk pools, PPACA drafters required that PCIP enrollees have gone without any form of health coverage, including state risk pool coverage, for at least 6 months.

Program critics originally predicted that millions of uninsured Americans with health problems would rush to enroll in the program and quickly use up federal PCIP funding. At the end of August, about 86,000 people were enrolled in the program.

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