Recently, the Department of Health and Human Services ("HHS") published interim regulations ("Regulations") announcing a health insurance program (the "Program") for individuals with pre-existing conditions. The Program is a result of a mandate in the Patient Protection and Affordable Care Act, as amended, that requires the Secretary of HHS to establish a temporary high-risk health insurance program to provide access to coverage for uninsured individuals with pre-existing conditions. Under the Program, coverage will be available to individuals with pre-existing conditions at the same rate as for an average person who does not have such a condition, meaning that health status will not affect the individual premium rate. The Program is entirely funded by the federal government but will be carried out by the states and/or non-profit entities.
The Regulations state that an individual is eligible to enroll in the Program if he or she:
- is a citizen or national of the United States or lawfully present in the United States;
- has not been covered under creditable coverage for a continuous 6-month period of time prior to the date on which the individual applies for the Program;
- has a pre-existing condition (as defined in the Regulations); and
- is a resident of one of the 50 states or Washington, D.C. that is within the service area of the Program.
The Program will remain in place until January 1, 2014, when individuals participating in the Program will transition to coverage purchased on a state exchange.
The text of the Regulations may be found here.