HHS Amends PCIP Program Eligibility

from Spencer’s Benefits Reports: The Department of Health and Human Services (HHS) has amended the eligibility requirements of the Pre-Existing Condition Insurance Plan (PCIP) to incorporate a new process announced by the Department of Homeland Security (DHS). The amendment to the interim final rules, originally published on July 30, 2010, was published in the August 30 Federal Register.

The Patient Protection and Affordable Care Act (ACA) established the PCIP, a temporary insurance program, for high risk individuals with preexisting conditions who have been uninsured for at least six months. The program will terminate on Jan. 1, 2014, when individuals enrolled in a PCIP will be transferred to coverage under a Health Insurance Exchange. As of June 30, nearly 78,000 individuals have enrolled in the PCIP program nationwide.

The interim final rule, issued on July 30, 2010, provided information on the administration of the PCIP program, eligibility for and enrollment in the program, program benefits, program oversight, program funding, coordination with state laws and programs, and the transition to coverage through the Health Insurance Exchanges. The interim final rule specified that individuals who are citizens of theU.S.or are lawfully present in theU.S.are eligible to participate in the PCIP. The interim final rule defined “lawfully present” as having a similar meaning as “lawfully residing” in Medicaid and the Children’s Health Insurance Program (CHIP).

In June 2012, the DHS announced that it will consider providing temporary relief from deportation by exercising deferred action with respect to individuals under age 31 who meet DHS’s guidelines, including that he or she came to theU.S.as a child and does not present a risk to national security or public safety. This process is being called Deferred Action for Childhood Arrivals (DACA).

However, the DACA process does not pertain to eligibility for Medicaid or CHIP. Therefore, the HHS is amending its definition of “lawfully present” in the PCIP program, according to the amendment, “so that the PCIP program interim final rule does not inadvertently expand the scope of the DACA process.” Under the amended rule, individuals with deferred action under the DACA process are not eligible to enroll in the PCIP program.

The regulations are effective on August 30. Comments may be submitted electronically at http://www.regulations.gov; or mailed to Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9995-IFC2,P.O. Box 8016,Baltimore,MD21244-8016.

For more information, contact Alexis Ahlstrom at (202) 690-7506.