Seed Grants to States for Qualified High-Risk Pools

To assist states in the creation and initial operation of a qualified high-risk health insurance pool for individuals who cannot purchase individual coverage because of pre-existing medical conditions.



Agency - Department of Health and Human Services

The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.

Office - Contact the appropriate CMS Regional Administrator.

(See Appendix IV for Regional Offices.)


Program Accomplishments

The program purpose is to assist states in the creation and initial operation of a qualified high-risk health insurance pool for individuals who cannot purchase individual coverage because of pre-existing medical conditions.

Uses and Use Restrictions

States that operated qualified high-risk pools (as defined in section 2744(c)(2) of the Public Health Service Act) prior to August 6, 2002, the date the Trade Act was signed into law, do not qualify for the grant funding.

All funds to be awarded under this program must be used exclusively for the creation and initial operation of a qualified high-risk pool as defined in section 2744(c)(2) of the Public Health Service Act.

Eligibility Requirements

Applicant Eligibility

Any State that did not have a qualified high-risk pool established as of August 6, 2002 is eligible to apply.

The term "State" is defined in the legislation as any of the 50 states and the District of Columbia.

The definition of a "qualified high-risk pool" is provided under section 2744(c)(2) of the Public Health Service Act.

Beneficiary Eligibility

Any State that did not have a qualified high-risk pool established as of August 6, 2002 is eligible to apply. The term "State" is defined in the legislation as any of the 50 states and the District of Columbia. The definition of a "qualified high-risk pool" is provided under section 2744(c)(2) of the Public Health Service Act.

Credentials/Documentation

Federal funds must go to a designated State Agency or its partner agencies.

Aplication and Award Process

Preapplication Coordination

A notice of intent to apply is encouraged but not required.

A notice of intent may be submitted to: CMS, Mailstop S3-16-16, 7500 Security Blvd, Baltimore, MD 21244-1850.

The letter of intent should indicate that the state intends to apply for a seed grant to create a "qualified" high-risk pool and also provide an estimate of the costs of creating the pool.

This program is excluded from coverage under E.O.

12372.

Application Procedures

In addition to the standard forms, some additional information regarding the authority for establishing the pool, plans for administering the pool, a contact person, and actions planned and already taken is also required. Applicants are required to submit an original and two copies of the application to the Acquisition and Grants Group, CMS, Mailstop C2-21-15 (Nicole Nicholson), 7500 Security Boulevard, Baltimore, MD 21244-1850. www.cms.hhs.gov/researchers/priorities/grants.asp. Facsimile (fax) transmissions will not be accepted. This program is subject to the provisions of OMB Circular No. A-102.

Award Procedures

The Centers for Medicare and Medicaid Services (CMS) will make a decision for each application received. Each applicant will receive written notification of CMS's decision. Applicants approved for a grant award must submit a letter of acceptance to CMS within 30 days of the date of the award, agreeing to the terms and conditions of the award letter.

Deadlines

Applications will be reviewed and funded on an ongoing basis as received. However, to be considered please contact program office for application deadline.

Authorization

Trade Act of 2002, Public Law 107-210; Deficit Reduction Act of 2005, Public Law 109-171.

Range of Approval/Disapproval Time

From 60 to 90 days.

Appeals

There are formal appeals procedures. If an application is disapproved, the reasons for disapproval will be fully stated.

Renewals

None.

Assistance Considerations

Formula and Matching Requirements

There is no requirement for States to match grants awarded under this program. Funding will be distributed to approved grant awardees in two phases. Funding will be released in Phase I once the State demonstrates that legal authority has been created to develop a qualified high-risk pool and that a governing authority responsible for overseeing the pool has been created or designated. Funding will be released in Phase II once the State has demonstrated that it has made the commitment to have the necessary staff available for the successful operation of the pool and has established the required administrative mechanism to assure the provision of health coverage.

Length and Time Phasing of Assistance

None.

Post Assistance Requirements

Reports

Grant awardees must submit a quarterly report to CMS documenting the expenditure of the grant funds and the progress of the creation of the high-risk pool.

These reports will continue to be submitted until all grant funds are spent.

Refer to 45 CFR Part 92.

Audits

All fiscal transactions identifiable to Federal financial assistance are subject to audit by DHHS audit agency.

Records

Proper accounting records, identifiable by project number and including all receipts and expenditures, must be maintained for 3 years. Subsequent to audit, they must be maintained until all questions are resolved.

Financial Information

Account Identification

75-0516-0-1-551.

Obigations

(Grants) FY 07 $1,450,000; FY 08 $0; and FY 09 est not available.

Range and Average of Financial Assistance

The maximum amount of a grant award is $1,000,000 as set in statute.

Regulations, Guidelines, and Literature

Grants Administration policies (45 CFR 74 and 92) application kits may be obtained from the Acquisition and Grants Group, CMS, Mailstop C2-21-15, 7500 Security Boulevard, Baltimore, MD 21244-1850. The grant application kits may also be downloaded from the following Web site: www.cms.hhs.gov/researchers/priorities/grants.asp.

Information Contacts

Regional or Local Office

Contact the appropriate CMS Regional Administrator. (See Appendix IV for Regional Offices.)

Headquarters Office

CMS, Centers for Medicaid and State Operations, Mailstop S2-01-16 (Paul Youket), 7500 Security Blvd, Baltimore, MD 21244-1850. Telephone: (410) 786-7528. E-mail: paul.youket@cms.hhs.gov.

Criteria for Selecting Proposals

A State must first meet the eligibility criteria (as stated above). If eligible, the application will be reviewed evaluating the State's mechanism that can reasonably be expected to assure administrative and legal capacity to provide health coverage to all qualified applicants and that funding sources that can reasonably be expected to ensure that the pool will be able to keep funding losses and stay in operation after grants funds have been expended.



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