June 2, 2010 -- Oregon is poised to receive $66 million over the next three years to run a federal high risk pool. A formal application was submitted to the Centers for Medicare and Medicaid Services yesterday.
If everything goes as planned, people can start enrolling July 1, with the program getting under way the following month, said Tom Jovick, administrator of the Office of Oregon Health Partnerships, which runs the Oregon high risk pool known as OMIP.
“The feds have to assure us that there’ll be no financial liability for the state; we want that in writing in the contract we sign,” he said.Unlike the state-run high risk pool, those who participate in the federal program won’t face a six month pre-existing waiting period but must have been uninsured for at least six months. Once they join the pool, their out-of-pocket expenditures cannot exceed $5,950 annually. The monthly premiums have not yet been determined. However, the benefits will be very comparable to the state-run pool, said Jovick, who projects a peak enrollment of 4,000 members over the next three years. Potentially, more than 50 percent of people who would normally join the state pool will be eligible for this federal program. “We’re trying to make it look as much like OMIP as we can even though the federal requirements for the benefit package are a little richer,” said Jovick who anticipates that 200-300 people will join the pool every month. Insurance agents will receive a onetime fee of $75 for everyone they enroll, not an ongoing commission. “We’re trying to make this relatively easy for consumers; they’ll be a single application to see if people are eligible for the federal pool. Our intent is to make this as seamless as possible.” Insurance assessments account for nearly 50 percent of the medical costs for the state-run pool. Last year they paid $90 million for the nearly 14,000 people covered, the remainder came from insurance premiums. Initially, insurers won’t face an assessment from the federal program – the $66 million is expected to cover the medical claims beyond the premiums for at least the first two years. However, if those federal dollars are exhausted, the members will be transferred to the state-run pool, and the insurers will once again be on the hook. “That’s the only option because there won’t be enough money to continue coverage on the federal pool,” Jovick said. “The feds told us over the phone that they like our proposal because it assures continuity of care.” Aside from the limit on out-of-pocket expenses, the benefits in both programs will be comparable, and Regence BlueCross BlueShield will remain as the third-party administrator and handle eligibility, enrollment, benefits, claims, case/disease management, the provider panel and customer service. Starting January 2014 both high risk pools will bite the dust, once the individual mandate kicks in. “Right now this program is moving like lightning,” Jovick said. “Normally the feds don’t move this fast; that surprises me. I don’t know why they decided to go with the high risk pool first. It probably has to do with political pressure in Washington DC.” TO LEARN MORE For more information about the state high risk pool or learn updated information about the federal program, go to www.omip.state.or.us.