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.



opportunity for State High Risk Pools that do not have an active CMS "Operational Losses" grant beyond March 31, 200 9. Total Amount of Funding:
up to $1,500,000
Related Programs

Grants to States for Operation of Qualified High-Risk Pools

Department of Health and Human Services

Who's Eligible

Obtain Full Opportunity Text:

Additional Information of Eligibility:
This is a COMPETITIVE opportunity for State High Risk Pools that do not have an active CMS "Operational Losses" grant beyond March 31, 2009.

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:

Linda GmeinerLinda.Gmeiner@cms.hhs.gov

Agency Email Description:
Linda Gmeiner

Agency Email:

Date Posted:

Application Due Date:

Archive Date:

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