Assistance program
Pre-existing Condition Insurance Program (PCIP)
-$1.3 Million committed in FY2018–FY2020
- Agency
- Centers for Medicare and Medicaid Services, Health and Human Services, Department of
- Assistance
- Direct Payments for Specified Use
- CFDA number
- 93.529
- What it does
- The Patient Protection and Affordability Care Act, was enacted on March 23, 2010. The Health Care and Education Reconciliation Act Public Law 111-152, was enacted on March 30, 2010. Collectively, these laws are known as the "Affordable Care Act." Section 1101 of the Affordable Care Act requires that the Secretary of the Department of Health and Human Services (HHS) establish, either directly or through contracts with States or nonprofit private entities, a temporary high risk health insurance program to provide access to coverage for uninsured Americans with pre-existing conditions. (Hereafter, we generally refer to this program as the Pre-Existing Condition Insurance Plan program, or PCIP program, to avoid confusion with the existing State high risk pool programs, which will continue to operate separately.) The PCIP program remained in place from the time of its establishment until April 30, 2014.
- Who benefits
- Eligibility and enrollment rules for the Federal and state-operated PCIP programs can be found at www.healthcare.gov or below as set forth in text from our Interim Final Regulation (IFR). B. Eligibility and Enrollment (Subpart C, Sec. 152.14 Through Sec. 152.15 of the PCIP IFR (45 CFR Part 152). Section 1101(d) of the Affordable Care Act provides the basic eligibility criteria for the PCIP program, which are set forth under Sec. 152.14. In addition, consistent with the Secretary's general authority under section 1101(c)(2)(D) of the Act to establish requirements for a PCIP, we set forth enrollment and disenrollment requirements in Sec. 152.15. In general, under section 1101(d) of the Affordable Care Act and subparagraphs (1), (2) and (3) of Sec. 152.14(a) of this interim final rule, an individual is eligible to enroll in a PCIP if he or she: (1) Is a citizen or national of the United States or is lawfully present in the United States as determined in accordance with section 1411 of the Affordable Care Act; (2) has not been covered under creditable coverage, as defined in section 2701(c)(1) of the Public Health Service Act as of the date of enactment, during the 6-month period prior to the date on which he or she is applying for coverage through the PCIP; and (3) has a pre-existing condition, as determined in a manner consistent with guidance issued by the Secretary. We further provide in Sec. 152.14(a)(4) that an individual must be a resident of a State that falls within the service area of a PCIP. Additional detail found in the IFR.
- Who applies
- The applicants must meet the terms and conditions outlined in the model contract. See the State PCIP Model contract at www.hhs.gov/cciio/Documents/state_hrp_model_contact.pdf
- Authorized by
- Patient Protection and Affordability Care Act, Section 1101
- Program site
- http://www.pcip.com ↗
Committed by fiscal year
Recipients
This program's money is paid out as non-itemized direct payments — USAspending records it under a single aggregate, so individual recipients aren't listed. The dollars and agencies above are complete; the recipient roster isn't part of the public record for programs like this.
How to read these numbers
- Committed through this program
Money committed under this assistance listing (its CFDA program), counted in the year each action happened.
- How it's paid
Most programs pay out one way — a grant, or a direct payment to individuals; the flow bar only appears when a program genuinely mixes types.
- Some recipients aren't itemized
For entitlement programs like Social Security and Medicare, the government reports one aggregate instead of naming tens of millions of people, so the recipient roster isn't part of the public record.
- Awards, counted once
An award count is the number of distinct awards with at least one action that year — each counted once, however many times it was amended.
- The colored bars
Every bar on this page splits by how the money moves:
Direct payments