PCIP Update: Smooth Sailing for California

By Arie Stock

While there may not be many standouts when you look at the latest state-by-state enrollment numbers for the Pre-Existing Condition Insurance Plan (PCIP), the recent enrollment boost in California’s federal high-risk pool, which now totals 4,294 enrollees, is welcome progress in this emerging public health insurance program. Just as we did with other successful PCIPs—North Carolina and New Mexico—we want to highlight some of the strategies that California has recently put to work to boost enrollment and make its application process more consumer-friendly:

  • A Single Application: California has two high-risk pools, a previously established state high-risk pool, known as the Major Risk Medical Insurance Program, and a new PCIP. In August of this year, California merged the applications for these two pools into one application. Now, people only need to fill out this single application to be automatically reviewed for both pools.
  • Accepting a Doctor’s Note as Proof of a Pre-Existing Condition: Also in August, California started accepting notes from licensed doctors, physician assistants, and nurse practitioners as verification that a person has or has ever had a pre-existing condition. This makes it easier for people with pre-existing conditions to qualify than before, when a rejection notice from a health insurance plan was required.
  • Increasing the Application Incentive: In October, California increased its payment to agents/brokers and Enrollment Entities from $50 to $100 for assisting successful PCIP applicants. These assisters—which include agents/brokers, schools, providers, hospitals, faith-based organizations, tax preparation specialists, and community based organizations—have existing relationships with those likely to be eligible for PCIPs and are often trusted sources of information on health insurance coverage. Offering them incentives to get the word out and get people enrolled has been another successful strategy for boosting enrollment.

It’s no coincidence that California, North Carolina, New Mexico, Pennsylvania, and New York are among the most successful state-administered PCIPs in the country. Each of these states uses some of these enrollment best practices to streamline and simplify the application process for eligible consumers, and all states can learn from their experiences to enhance their own PCIP enrollment numbers.


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