PCIP Enrollment Could Be Capped in Two Months

by David Gorn

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State officials may need to curtail enrollment in the federally funded Pre-Existing Condition Insurance Plan in as little as two months from now, if more federal dollars aren't allocated to it.

That was the word last week from the Managed Risk Medical Insurance Board, which oversees the federal PCIP program. It was surprising news, given its history since the program launched last year.

Every month, at every board meeting, the report was always the same -- that the flow of enrollees into the program was increasing, but at a surprisingly slow rate.

The threshold for the number of Californians who might participate in PCIP was estimated at about 23,000 people. Since a few more than 5,000 people signed up in that first year -- and new enrollees came on board at a rate of roughly 500 a month -- it seemed that the program was financially stable and able to take on more participants.

But after the first year, state officials got their first real claims data to test that estimate, and the amount required by recipients was much higher than expected. That 23,000-person threshold estimate was reduced to 6,800 Californians.

That means (given current enrollment of 5,290 including last month's bump of 726 new subscribers), there's now only room for a little more than 1,500 new enrollees (which is about two months' worth of enrollees, given October's bump of 726 new subscribers).

Unless the federal government pumps more money into the program.

"If we were talking 23,000 people, [the federal funding level] wouldn't matter so much," board member Richard Figueroa said. "Now that we know the claims numbers are three times as high, that could be a problem."

The claims cost estimates were based on a similar state-financed program, the Major Risk Medical Insurance Program. But the federal program doesn't have the caps of MRMIP, and so the claims numbers jumped, according to MRMIB Chair Cliff Allenby.

"The annual cap is not there in PCIP," Allenby said, "and apparently that makes a big difference."

The board is drafting a letter to federal officials this week, to explain the potential enrollment limit. Since some states don't have a PCIP program, it's possible that funds might be shifted over to California, Allenby said.

"We'll give the feds an opportunity to allocate more funds," he said. "It's their program. It's their decision."


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