Operational Grants to States for High Risk Pools

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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. The following grant opportunities are available to states operating qualified high-risk pools: Grants for Operational Losses- States that have established a qualified high risk pool that has incurred losses and (1) restricts premiums charged under the pool to no more than 200 percent of the premium for applicable standard risk rates; (2) offer 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. Special Rule for Pools Charging Higher Premiums - In the case of a qualified high-risk pool of a state which charges premiums that exceed 150 percent of the premium for applicable standard risks, the State shall use at least 50 percent of the amount of the grant provided to the state to reduce premiums for enrollees. Bonus Grants for Supplemental Consumer Benefits - States that have established a qualified high risk pool and are receiving grants for operational losses are eligible to apply for a grant to be used to provide supplemental consumer benefits to enrollees or potential enrollees (or defined subsets of such enrollees or potential enrollees) in qualified high risk pools.

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