California is launching a new federally funded high-risk pool on September 1 – without the participation of Kaiser Permanente or Anthem Blue Cross.
The Preexisting Condition Insurance Plan will operate alongside the existing state-run pool, in which the two big healthcare payers participate.
Both programs will be terminated at the end of 2013, when the provision to provide coverage to uninsured individuals who have been denied insurance or faced unaffordable plans under the Patient Protection and Affordable Care Act of 2010 kicks in.
To be eligible for the new program, enrollees must have lacked health insurance coverage for the last six months, said John Symkowick, a spokesman for California's Managed Risk Medical Insurance Board (MRMIB). Enrollees in the current program can't shift over, he said.
Kaiser Permanente covers more than 4,000 lives under the existing program, while Anthem covers nearly 3,000 lives.
"To meet the law's rapid deadlines, the state of California understandably opted to use a financial intermediary (third-party administrator) to make fee-for-service payments to healthcare providers," said Trish Doherty, a spokeswoman for Kaiser. "As a predominantly prepaid healthcare provider, Kaiser Permanente is not organized in a manner that allows us to easily participate in this new program."
"Anthem Blue Cross supports the development of the high-risk pool as a method to increase access to healthcare coverage, however, this pool is temporary in nature and, based on our discussions with the state, would require significant changes to our existing systems in order to implement," said spokeswoman Peggy Hinz. "This would direct resources away from the other necessary product and administrative changes that we must make to implement new federal healthcare reform requirements."
The state is in negotiations with MAXIMUS to provide administrative services and HealthNow Administrative Services to provide third-party administrator services.
While the MRMIB doesn't know what the demand for the new program will be, 5,400 requests for applications have been filed as of August 24, said Symkowick.