Health Insurance: State High-Risk Pools

Health Insurance: State High Risk Pools
Updated October 1, 2008
Bernadette Fernandez
Analyst in Health Care Financing
Domestic Social Policy Division



Health Insurance: State High Risk Pools
Summary
In an effort to expand the options for health coverage, 34 states have established
high risk health insurance pools. These programs target individuals who cannot
obtain or afford health insurance in the private market, primarily because of pre-
existing health conditions. Also, many states use their high risk pools to comply with
the portability and guaranteed availability provisions of the Health Insurance
Portability and Accountability Act of 1996 (P.L. 104-191).
In general, high risk pools tend to be small and enroll a small percentage of the
uninsured. As of the end of 2006, 190,462 individuals were enrolled in these pools.
State-established nonprofit organizations typically run these pools, with private
insurance companies handling day-to-day operations. Although benefit packages
vary across states and plans, they generally reflect health benefits that are available
in the private insurance market. The majority of high risk pools cap premiums
between 125% to 200% of market rates, and pools are subsidized through insurer
assessments and other funding mechanisms.
Congress has acted in recent years to fund the expansion and operation of state
high risk pools. The Trade Act of 2002 (P.L. 107-210) appropriated a total of $100
million for FY2003-FY2004. With the expiration of authorizing legislation forth
federal funding of state pools, the 109 Congress took up this issue. The House
passed H.R. 4519, the State High Risk Pool Funding Extension Act of 2006, on
December 17, 2005. H.R. 4519 reauthorized federal grants to state high risk pools
through FY2010, and changed the funding formula used for such grants. The Act
authorized the following amounts for FY2006: $15 million for seed grants and $75
million for operational and bonus grants. The Senate passed H.R. 4519 without
amendment on February 1, 2006, and President Bush signed it into law (P.L. 109-

172) on February 10, 2006.


As part of the budget reconciliation process, the Senate passed S. 1932, the
Deficit Reduction Act of 2005 (DRA) conference agreement, which provided
appropriations for the grants authorized under H.R. 4519. The measure also included
conforming language on enactment of H.R. 4519. The House agreed to the Senate-
amended DRA bill on February 1, 2006, and President Bush signed it into law (P.L.
109-171) on February 8, 2006. The Centers for Medicare and Medicaid Services
(CMS) awarded grants to 31 states that experienced operational losses in 2005. Of
those 31 states, 25 also received bonus grants. In 2006, CMS awarded seed grants
to five states, and to another five states in 2007.
The 110th Congress took up the issue of extending the federal grant program by
making funding available pursuant to the Consolidated Appropriations Act of 2008
(P.L. 110-161). The grant funding totaled $49,127,000. In July 2008, CMS
announced that 30 states received operational and bonus grants totaling $49,126,500.
This report will be updated periodically.



Contents
In troduction ......................................................1
Health Insurance Context........................................2
Health Policy Context..........................................3
State High Risk Pools..............................................4
General Characteristics of State High Risk Pools.....................4
Administration ............................................4
Premiums and Funding.....................................4
Benefits .................................................5
Eligibility ................................................5
Enrollment ...............................................6
Federal Grants to State High Risk Pools................................6

107th Congress................................................6th


109 Congress................................................9
110th Congress...............................................11
List of Tables
Table 1. Operational Grants Awarded to State High Risk Pools, FY2003
and FY2004..................................................8
Table 2. Operational and Bonus Grants Awarded to State High Risk Pools,
FY2006 ....................................................10
Table 3. Combined Operational and Bonus Grants Awarded to State High
Risk Pools, FY2008...........................................12



Health Insurance: State High Risk Pools
Introduction
In an effort to expand the options for health coverage and reduce the number of1
uninsured, a majority of states have established high risk health insurance pools.
These programs target individuals who cannot obtain or afford health insurance in
the private market. High risk pools generally cover people who have sought health
coverage in the individual (nongroup) market, but have been denied coverage,
received quotes from insurers that are higher than the premiums offered by the high
risk pools, or received offers from insurers that permanently exclude coverage of pre-2
existing health conditions.
Many states also use their high risk pools to comply with the portability and
guaranteed availability provisions of the Health Insurance Portability and
Accountability Act of 1996 (HIPAA, P.L. 104-191). For eligible individuals moving
from the group to nongroup market, HIPAA requires state-licensed health insurers
to make coverage available to such individuals, and prohibits exclusion of coverage
for pre-existing conditions. Of the 34 states currently operating high risk pools, 28
states use their pools to comply with HIPAA’s portability and guaranteed availability
provisions.3
In general, state high risk pools tend to be small and enroll a small percentage
of the uninsured. At the end of 2006, 190,462 individuals were enrolled in these
pools,4 compared with over 31 million people who were uninsured in states with high


1 National Association of State Comprehensive Health Insurance Plans, Comprehensive
Health Insurance for High-Risk Individuals: A State-By-State Analysis, Twentieth Edition,
2006/2007, 2006. (Hereafter cited as Comprehensive Health Insurance.) For online
information about state high risk pools, see State Coverage Initiatives, “High-Risk Pools,”
at [http://www.statecoverage.net/matrix/highriskpools.htm].
2 A medical condition for which treatment was recommended or received, or medical advice
was sought, prior to enrollment.
3 To comply with these provisions, states may either enforce the HIPAA individual market
guarantees (“federal fallback”), or establish an “acceptable alternative state mechanism,”
such as a high risk health insurance pool. For more information about HIPAA, see CRS
Report RL31634, The Health Insurance Portability and Accountability Act (HIPAA) of
1996: Overview and Guidance on Frequently Asked Questions, by Hinda Chaikind, Jean
Hearne, Bob Lyke, and Stephen Redhead. (Hereafter cited as CRS Report RL31634.)
4 Enrollment for Idaho’s pool is from the end of June 2006. Since Tennessee’s pool was
established in 2007, there is no enrollment data for the state.

risk pools operating that year.5 However, such limited enrollment reflects, in part,
the narrow focus of these pools: individuals with costly health conditions who seek
coverage in the private market.
Health Insurance Context
High risk pools fill a niche in the health insurance system — a patchwork
system of private markets and public programs designed to meet the needs of
different types of health care consumers.6 In the private health insurance market,
most people get health coverage through the group market. This market provides
health benefits to groups of people that are drawn together by an employer or other
organization, such as a trade union. Such groups are generally formed for some
purpose other than obtaining insurance, like employment.
While most Americans receive their health coverage through the workplace —
as a current employee, a dependent of an employee, or a retiree — some individuals
do not have access to employer-sponsored insurance (ESI). They may be workers
who do not qualify for an offer of health benefits from their employer (e.g., because
the workers have part-time or seasonal employment status), or they may work for a
company that does not provide health insurance at all, or they may be unemployed.
Public programs also are a source of health coverage, but individuals and families
must meet eligibility requirements in order to qualify for benefits. Individuals who
cannot access ESI and are not eligible for public programs may seek health insurance
in the nongroup (individual) market.
Applicants to the individual insurance market must go through robust medical
underwriting — the process by which an insurer considers information about an
applicant and determines (1) whether to offer an insurance policy in the first place,
and (2) the terms of that policy (e.g., the monthly premium). The information that
a health insurer considers may include personal characteristics, such as an
individual’s health conditions, family medical history, and other relevant factors.
Though uncommon, the insurance carrier may ask an applicant to undergo a physical
exam, or provide specimens. In the group market, insurers forgo underwriting in the
traditional sense, that is, reviewing each person’s demographics and medical history.
Instead, an insurer would consider the overall characteristics of the group, and
calculate a premium for a set of benefits that would be charged to each person in the
group, regardless of their individual health status. (For very small groups, insurers
may individually underwrite policies, if permitted by law.)
Federal and state laws restrict somewhat insurers’ ability to reject applications
or design coverage based on health factors in the nongroup market. Nonetheless,
some applicants are rejected from the individual market altogether, others may
receive insurance offers with riders that exclude coverage for a specific health
condition or body part, or others may be charged premiums that are higher than those


5 CRS calculation of uninsured in states with high risk pools. Data source: Current
Population Survey (CPS), CPS Table Creator, at [http://www.census.gov].
6 For a general discussion about health insurance, see CRS Report RL32237, Health
Insurance: A Primer, by Bernadette Fernandez.

in the group market for similar coverage.7 Rigorous underwriting results in an
enrollee population in the individual market that is fairly healthy (three out of four
enrollees report that their health is excellent or very good8), thereby excluding
persons with moderate to severe health conditions from this private market. High
risk pools were designed to assist such individuals who — because of their health
conditions — have very few options for private health coverage.
Health Policy Context
High risk pools appeal to policymakers who prefer an incremental approach to
coverage expansion and reliance on current state oversight of health insurance.9
Supporters of high risk pools contend that states can use their existing regulatory
infrastructure, as well as their knowledge of health care markets, to efficiently insure
previously uninsurable individuals. Supporters also contend that the private,
nongroup market will benefit. They reason that by removing high risk persons from
the individual market and placing them in publicly-subsidized insurance pools,
coverage in the individual market will become more affordable. They argue that
better risk spreading helps to stabilize the market, promote competition, and retain
insurance carriers — earning the support of such organizations.10 Moreover, high
risk pools function as a safety net for the nongroup market by assuring that
individuals have access to health insurance as long as they are able and willing to pay
for it.
Others contend that high risk pools are generally too small and underfunded to
meet the needs of the majority of persons who cannot access health insurance in the
private market. By design, high risk pools experience losses, but federal attempts to
subsidize these losses have been limited. Waiting lists for enrollment are common,
and premiums combined with other cost-sharing requirements can often make the
coverage offered by these pools unaffordable. As a result, some researchers remain
skeptical that high risk pools will be able to substantially reduce the number of


7 M. Pauly and A. Percy, “Cost and Performance: A Comparison of the Individual and
Group Health Insurance Markets,” Journal of Health Politics, Policy and Law, February

2000.


8 General Accounting Office, “Private Health Insurance: Millions Relying on Individual
Market Face Cost and Coverage Trade-Offs,” November 1996.
9 For example, see National Governors Association, Policy Position, “Private Sector Health
Care Reform Policy,” December 14, 2000. Also, see examples from advisory groups and
academia, such as the National Association of Insurance Commissioners, News Release,”
NAIC Applauds Extension of Federal Funding for High-Risk Pools,” July 27, 2005, and M.
Pauly, “How Private Health Insurance Pools Risk,” National Bureau of Economic Research,
Research Summary, Summer 2005.
10 For example, see the National Association of Health Underwriters’ position on high risk
pools at [http://www.nahu.org/government/issues/Risk_Pools/High_Risk_Pools.htm], and
the Council for Affordable Health Insurance’s issue brief on high risk pools at
[ ht t p: / / www.cahi .or g/ cahi _cont ent s / i ssues/ a r t i c l e .asp?i d=489] .

uninsured, particularly among those with serious medical conditions.11 With respect
to reducing the number of people without health coverage, consumer groups
generally advocate for expansion of the federal role in providing coverage, whether
through existing public programs or broader health care reform.12
While high risk pools have existed since the mid-1970s, only recently has
Congress acted to support the expansion and operation of high risk pools across the
country. The enactment of HIPAA during the 104th Congress specified state high risk
pools as acceptable mechanisms for complying with the group-to-individual market
requirements. The 107th Congress passed the Trade Act of 2002 (P.L. 107-210),
which authorized a new federal program to provide grants to state high risk pools and
made appropriations for FY2003 and FY2004. With expiration of the authorizing
legislation for the grant program to states, the 109th Congress reauthorized the
program through FY2010 and made appropriations for FY2006. The 110th Congress
passed legislation in December 2007 to provide additional appropriations. (See
detailed discussion under “Federal Grants to State High Risk Pools” section.)
State High Risk Pools
In 2007, 34 states had high risk health insurance pools. States have a great deal
of discretion regarding the establishment and operation of these pools, including
covered benefits, eligibility requirements, pre-existing condition exclusion periods,
and funding sources.
General Characteristics of State High Risk Pools
Administration. State high risk pools usually are operated through state-
established nonprofit organizations. While private insurance companies typically
are responsible for daily administrative duties, the pools themselves bear the risk.13
Boards oversee the management of high risk pools and usually consist of
representatives from insurance companies, consumer groups, health care providers,
and state agencies.
Premiums and Funding. In order to limit the cost of health coverage for
persons with costly medical conditions, all states cap high risk pool premiums.


11 For example, see D. Chollet, “Expanding Individual Health Insurance Coverage: Are
High-Risk Pools The Answer?,” Health Affairs, October 23, 2002, and Pollitz, et al., “Health
Insurance and Diabetes: The Lack of Available, Affordable, and Adequate Coverage,”
Clinical Diabetes, vol. 23, no. 2, 2005.
12 For example, see testimony presented by R. Pollack, Families USA, Education and the
Workforce Committee Employer-Employee Relations Subcommittee hearing, “Expanding
Access to Quality Health Care: Solutions for the Uninsured,” July 9, 2002, and American
Federation of State, County, and Municipal Employees, “Universal Health Coverage,”
resolution no. 14, June 26-30, 2000.
13 A high-risk pool essentially functions as the health plan and is responsible for paying
claims. In general, the insurance carrier’s role is for administrative purposes only.

Almost all states have caps between 125% and 200% of standard market rates. A
majority of states offer coverage at less than 150% of the average. High risk pools
generally operate at a loss, “because it isn’t feasible to pool a group of individuals
known to have major health problems and expect their premium contributions to
cover the entire cost.”14 Thus, many state pools tap other sources of funding to cover
their operating expenses.
States may augment premium collection with one or more of the following
sources: assessments on insurers, in some instances combined with offsetting tax
credits; state funds; and other sources.15 Almost all states with risk pools assess a fee
on insurance carriers, although 13 of those states offset those assessments with tax
credits. Eleven states use general revenue for additional risk pool funding, while
only two states use monies from hospital assessments.
Benefits. Although health benefits provided through risk pools vary across
plans and states, they generally reflect coverage that is available in the private
market. States usually offer more than one plan from which enrollees may choose.
Deductibles and other cost-sharing requirements vary from state to state. Most state
pools do not place maximum annual limits on benefits, except for California, Idaho,
Kansas, Louisiana, Tennessee, Utah, and West Virginia. In contrast, nearly all pools
have lifetime maximums on benefits, except for Indiana, Kentucky, and New
Mex i co. 16
Eligibility. States establish the eligibility criteria for high-risk pools. As noted,
many states allow HIPAA-eligible persons to enroll in their high risk pools. HIPAA
eligibles are persons who do not have or are losing coverage and seeking it in the
individual market.17 They must meet the following requirements: (1) have at least
18 months of “creditable coverage” (specified in statute) without a significant break
in that coverage (63 or more days); (2) most recent coverage must have been through
a group health plan; (3) exhausted federal or state continuation coverage; (4) not
eligible for Medicaid or Medicare; and (5) not have any other health insurance. For
HIPAA eligibles, high risk pools guarantee the availability of health insurance and
prohibit exclusion of coverage for pre-existing conditions. Risk pools also are
designed to address the insurance needs of non-HIPAA-eligible persons with costly


14 Communicating for Agriculture and the Self-Employed, Inc., Comprehensive Health
Insurance for High-Risk Individuals: A State-By-State Analysis, Nineteenth Edition,

2005/2006, 2005, p. 14.


15 An assessment is a tax or fee. Some states fund the losses of their risk pools by requiring
insurers across the state to pay assessments. Generally, the amount of insurers’ assessment
is based on their share of the total premiums sold in the state for each year. Some states also
provide tax credits to these insurers, thus reducing the insurers’ tax liability and enabling
them to recover some or all of their expenditures on the assessments. Under the latter of
these funding mechanisms, the state assumes part or all of the cost burden for the losses of
the risk pools.
16 In KS, annual maximum applies to certain plans. In FL and KY, no lifetime maximums
apply to specified plans.
17 HIPAA also provides protections to certain people who wish to enroll in the group health
insurance market. See the aforementioned CRS Report RL31634 for more details.

medical conditions. A number of states provide for presumptive eligibility, allowing
individuals to become automatically eligible for high-risk pools if they have a certain
medical condition specified under state law. In addition to HIPAA eligibles and
persons with specific conditions, many states allow individuals who have
experienced coverage denials, coverage restrictions, or premium increases to enroll
in high risk pools.
Enrollment. High risk pool participation varies significantly across states,
with enrollment ranging from a high of 29,089 participants in Minnesota to a low of
345 enrollees in West Virginia.18 Among state high risk pools, the enrollment
distribution clusters toward the low end. To illustrate, almost one-third of high risk
pools with 2006 enrollment data had pools below 2,000 participants (10 states), and
two-thirds of state pools had participation below 4,000 (23 states). In contrast, only
six states had more than 10,000 participants. As for new enrollment, all states but19
Florida are accepting new participants.
Federal Grants to State High Risk Pools
Given that state high risk pools typically operate at a loss (see discussion above),
the federal government has provided financial assistance to states during the past
several years. Congress established a grant program, administered by the Centers for
Medicare and Medicaid Services (CMS), to provide seed grants to states that did not
already have high risk pools but wanted to establish them, and operational grants to
existing state pools. Once Congress appropriates funding for these grants, CMS
announces the funding opportunity and collects and reviews applications. A state
may receive up to $1 million in seed grant funding; operational grant amounts are
determined by formula. (Not all states with existing high risk pools receive grants.)20
107th Congress
With enactment of the Trade Act of 2002 (P.L. 107-210), the federal
government provided funding to state high risk health insurance pools for the first
time. The Trade Act authorized and appropriated $20 million in the form of seed
grants. Each qualifying state could receive up to $1 million to support the creation
and implementation of a high risk pool. In 2003, CMS awarded seed grants to six
states: Maryland ($1 million), New Hampshire ($1 million), Ohio ($150,000), South
Dakota ($1 million), Utah ($52,618), and West Virginia ($1 million).21


18 The applicable date for enrollment data varies from state to state. For the newest high risk
pool, Tennessee, no enrollment data are yet available.
19 Data sources: Kaiser Family Foundation, “State High Risk Pool Programs and Enrollment,
2007”, at [http://www.statehealthfacts.org/comparetable.jsp?ind=602&cat=7], and
Comprehensive Health Insurance.
20 For additional information about the grant program administered by CMS, see High Risk
Pool Overview, at [http://www.cms.hhs.gov/HighRiskPools/].
21 Ohio was awarded a grant to conduct a study on the feasibility of creating a high risk pool.
(continued...)

The Trade Act also authorized and appropriated $80 million to be split evenly
over FY2003 and FY2004 to defray some of the operating losses experienced by
states with existing high risk pools. Each operational grant could cover up to 50%
of a pool’s operating losses for the year. To qualify, each state must have established
a risk pool that restricts premiums to no more than 150% of the premium for standard
risk rates in the state, offers a choice of two or more coverage options, and has in
effect a mechanism designed to ensure continued funding of losses incurred after the
end of FY2004. However, states may still be able to determine, within federal
standards, how much to charge enrollees in out-of-pocket costs, what benefits to
include under the plans, how long coverage for pre-existing conditions may be
excluded, and whom among otherwise uninsurable individuals will be eligible.
Table 1 shows which states received operational grants for FY2003 and
FY2004, and the funding levels. Nineteen states were awarded operational grants in22


FY2003; 22 states in FY2004.
21 (...continued)
Utah was awarded a grant to modify its existing health plan and become a newly “qualified”
high risk pool.
22 The FY2004 grantees include Massachusetts which operates a reinsurance program for
the non-group market that differs from traditional high risk pools. Nonetheless, the MA
program met the requirements of the federal grant program. For a more detailed discussion
about the MA reinsurance program, see Comprehensive Health Insurance, p. 261.

Table 1. Operational Grants Awarded to State High Risk Pools,
FY2003 and FY2004
Grant amount, FY2003Grant amount, FY2004
State($, thousands)($, thousands)
Alabama2,826
Alaska 542 484
Arkansas 1,928 1,893
Co lo rado 3,219 3,096
Co nnecticut 1,597 1,503
I llino is 8 ,1 4 4 7 , 4 7 3
Indiana 3 ,266 3,358
Iowa 1,107 368
Kansas 1,462 1,297
Kentucky 2,511 2,292
Maryland 3,176
Massachusetts 132
Minneso ta 1,984 1,972
Mississippi 2,066 2,038
Montana 698 621
Nebraska 894 751
New Hampshire225532
New Mexico2,0481,739
North Dakota329293
Oklaho ma 2,931 2,731
Utah 1,395
Wisconsin 2 ,222 2,501
Wyoming 358
Sources: Centers for Medicare and Medicaid Services, HHS Awards Grants to Twenty-two States
to Offset Costs of Insurance for Residents Too Sick for Conventional Coverage, News Release,
October 5, 2005; and K. Pollitz and E. Bangit, “Federal Aid to State High-Risk Pools: Promoting
Health Insurance Coverage or Providing Fiscal Relief?” Issue Brief, November 2005.
Note: Grant amounts are rounded to the nearest thousand.



109th Congress
With expiration of authorizing legislation for the grant program, the House
passed H.R. 4519, the State High Risk Pool Funding Extension Act of 2006, on
December 17, 2005. H.R. 4519 reauthorized federal grants to state high risk pools
through FY2010, and changed the funding formula used for such grants. The
formula for operational grants was changed to the following: 40% to all qualifying
states in equal amounts, 30% based on state proportion of uninsured population
among all qualifying states, and 30% based on state proportion of the high risk pool
population. H.R. 4519 also allowed operational grants to cover up to 100% of pool
losses and authorized the following amounts for FY2006: $15 million for seed grants
and $75 million for operational and bonus grants. The Senate passed H.R. 4519
without amendment on February 1, 2006, and President Bush signed it into law (P.L.

109-172) on February 10, 2006.


As part of the budget reconciliation process, the Senate passed S. 1932, the
Deficit Reduction Act of 2005 (DRA) conference agreement. DRA included
provisions that would provide specific appropriations for the grants authorized under
H.R. 4519. Section 6202 of the Senate measure amended the Public Health Service
Act to provide $90 million in appropriations for grants to states for FY2006. DRA
provided $75 million for operational grants and $15 million for seed grants. The
grants are distributed according to existing statutory requirements. This measure also
included conforming language on enactment of H.R. 4519. Pursuant to H.Res. 653,
the House agreed to the Senate-amended bill on February 1, 2006. On February 8,

2006, President Bush signed DRA into law (P.L. 109-171).


The appropriations provided under DRA were used to extend federal funding
for this program. On September 30, 2006, CMS awarded seed grants to five states
that wanted either to establish high risk pools or conduct feasibility studies:
California ($150,000), New York ($150,000), North Carolina ($150,000), Tennessee
($1 million), and Vermont ($1 million). That same year, CMS awarded grants to 31
states that experienced operational losses in 2005. Of those 31 states, 25 also
received bonus grants, exhausting the entire appropriations for operational and bonus
grants. Table 2 shows which states received operational and bonus grants.
Because the funding for seed grants was not exhausted with the 2006 awards,
CMS awarded five seed grants in 2007. The states that received these grants were
the District of Columbia ($150,000), Florida ($150,000), Georgia ($150,000), North
Carolina ($850,000), and Rhode Island ($150,000).



Table 2. Operational and Bonus Grants Awarded
to State High Risk Pools, FY2006
OperationalTotal Grant Award
StateGrants ($)Bonus Grants ($)($)
Alabama 1,442,972 0 1,442,972
Alaska 790,482 895,640 1,686,122
Arka nsas 1,253,047 55,900 1,308,947
Colorado 1,658,396 1,478,373 3,136,769
Connecticut 1,147,452 700,000 1,847,452
Idaho 960,424 0 960,424
Illinois 2,939,767 1,250,000 4,189,767
Indiana 1,926,155 942,000 2,868,155
Io wa 994,340 0 994,340
K a nsas 1,031,608 295,000 1,326,608
K e ntucky 1,406,506 975,000 2,381,506
Louisiana 1,354,951 992,713 2,347,664
Maryland 1,797,813 1,200,000 2,997,813
Massachusetts 414,569 0 414,569
Minnesota 3,664,879 2,000,000 5,664,879
Mississippi 1,392,593 449,202 1,841,795
Missouri 1,409,440 1,000,000 2,409,440
Montana 1,074,800 729,875 1,804,675
Nebraska 1,273,440 934,097 2,207,537
Ne w 826,355 782,644 1,608,999
Hampshire
New Mexico1,121,553950,0002,071,553
North Dakota867,5730867,573
Oklahoma 1,388,788 1,000,000 2,388,788
Oregon 2,375,581 1,500,000 3,875,581
South Carolina1,278,624700,0001,978,624
South Dakota785,577312,8511,098,428
T e xas 7,237,175 2,000,000 9,237,175
Utah 1,162,603 1,250,000 2,412,603
Washington 1,575,759 856,705 2,432,464
Wisconsin 2,672,935 1,750,000 4,422,935
Wyoming 773,843 0 773,843
Sources: Grant data available at [http://www.cms.hhs.gov/HighRiskPools/Downloads/grant
awardslist1106.pdf].



110th Congress
Pursuant to the Consolidated Appropriations Act of 2008 (P.L. 110-161),
Congress made additional funding available for grants to state high risk pools. CMS
issued a grant notification letter to states on May 1, 2008. It stated that a total of
$49,127,000 would be split to fund operational grants (two-thirds of the appropriated
amount) and bonus grants (remaining one-third).23 Applications were due by June

9, 2008.


On July 21, 2008, CMS announced that 30 states received grants totaling $49,
126,500. Table 3 shows which states received grants and the combined grant
amounts.


23 For additional information, see the funding announcement online at
[ h t t p : / / www.cms.hhs.gov/ Hi ghRi s kPool s/ Do w n l o a d s / F i n a l _ F Y 08_HRP_announcement.
pdf].

Table 3. Combined Operational and Bonus Grants Awarded
to State High Risk Pools, FY2008
StateTotal Grant Award ($)
Alabama 1,383,432
Alaska686,427
Arkansas923,943
Colorado 1,810,579
Connecticut 1,179,518
Idaho966,948
Illinois 2,997,696
Indiana 1,706,495
Iowa713,258
Kansas1,085,624
K e ntucky 1,688,275
Louisiana 1,437,094
Maryland 2,301,233
Minnesota 3,442,001
Mississippi 1,414,808
Missouri 1,491,340
Montana 1,054,073
Nebraska 1,195,503
New Hampshire882,252
New Mexico1,440,929
North Dakota703,531
Oklahoma 1,392,608
Oregon2,680,650
South Carolina1,444,730
South Dakota724,609
Texas6,276,063
Utah1,393,329
Washington 1,617,258
Wisconsin 2,561,169
Wyoming504,125
Total49,126,500
Sources: Grant data available at [http://www.cms.hhs.gov/HighRiskPools/Downloads/

2008HRPAWARDS.pdf].