A recent Government Accountability Office (GAO) report on the federal Preexisting Condition Insurance Plan (the PCIP) noted that the fledgling program had enrolled only a fraction of its anticipated enrollees during its first year. Initially the PCIP permitted individuals to obtain subsidized health insurance only if they obtained documentation that they were denied health insurance coverage because of pre-existing medical conditions. In the last six months the PCIP has relaxed this criteria to include individuals: (i) who have a documented pre-existing medical condition that may result in a denial of coverage; or (ii) who have a documented increased premium rate because of a pre-existing medical condition. Health care providers who routinely provide care to uninsured individuals should be mindful of these eligibility changes and consider assisting these eligible individuals to enroll in the PCIP and obtain health care insurance.

The PCIP was created by the Patient Protection and Affordable Care Act (PPACA) in March 2010 to provide a subsidized high-risk insurance pool to individuals who were denied creditable coverage because of a pre-existing medical condition. PPACA allocated $5 billion to the PCIP to pay for the PCIP’s administrative expenses and the health care claims made by enrollees. The $5 billion was provided to fund the program until its termination on January 1, 2014, at which time the individuals enrolled in the PCIP are expected to obtain health insurance via the soon-to-be-implemented health insurance exchanges.

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