Opportunity Information: Apply for HHS 2008 CMS HRP 0004
Apply for HHS 2008 CMS HRP 0004
- The Centers for Medicare Medicaid Services in the health sector is offering a public funding opportunity titled "Operational Grants to States for High Risk Pools" and is now available to receive applicants.
- Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.780 Grants to States for Operation of Qualified High Risk Pools.
- This funding opportunity was created on Apr 7, 2008 and posted on Apr 4, 2008.
- Applicants must submit their applications by Jun 9, 2008 See link to full announcement for details.. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
- The funding agency has allocated a total of $49,127,000.00 to eligible and selected applicants.
- The number of recipients for this funding is limited to 32 candidate(s).
- Eligible applicants include: Others (see text field entitled Additional Information on Eligibility for clarification).
- This is a COMPETITIVE opportunity for State High Risk Pools with an active CMS grant that has been awarded a no cost extension beyond March 31, 2008, see section below entitled Competitive Continuation Grants. 1. Eligibility Criteria A qualified high risk pool as defined in sections 2744(c)(2) and 2745(g) of the PHS Act is a risk pool that (a) provides to all eligible individuals health insurance coverage (or comparable coverage) that does not impose any preexisting condition exclusion with respect to such coverage for all eligible individuals, except that it may provide for enrollment of eligible individuals through an acceptable alternative mechanism (as defined for purposes of section 2744) that includes a high risk pool as a component, and (b) provides for premium rates and covered benefits for such coverage consistent with standards included in the NAIC Model Health Plan for Uninsurable Individuals Act that was in effect at the time of the enactment of the Health Insurance Portability and Accountability Act of 1996 (August 21, 1996). To be eligible for a grant, a state must have an established qualified high risk pool that has incurred losses and (1) restricts premium charged under the pool to no more than 200 percent of the premium for applicable standard risk rates (2) offers 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. The state must provide sufficient documentation of the losses incurred in the operations of the qualified high risk pool for the covered grant period.
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Opportunity Summary:
Operational Grants to States for High Risk Pools (HHS-2008-CMS-HRP-0004) is a CMS discretionary grant program created to help states cover the operating losses of qualified state high risk health insurance pools. The funding comes from appropriations authorized under section 2745(d)(1)(B) of the Public Health Service Act, and it is aimed at stabilizing these pools so they can continue offering coverage to people who are considered high risk and typically have difficulty obtaining insurance in the broader market. The program is structured around offsetting documented financial losses tied to running an eligible pool, rather than paying for start-up costs or general program expansion.
To qualify, a state must operate a "qualified high risk pool" as defined in sections 2744(c)(2) and 2745(g) of the PHS Act. In practical terms, that means the pool has to make coverage available to all eligible individuals without imposing a preexisting condition exclusion (though states may use an acceptable alternative enrollment mechanism, as long as a high risk pool is part of it). The pool also has to set premium rates and covered benefits consistent with standards in the NAIC Model Health Plan for Uninsurable Individuals Act that was in effect when HIPAA was enacted (August 21, 1996). Beyond meeting the statutory definition, a state has to show that the pool has actually incurred losses during the relevant period and provide enough documentation to substantiate those losses.
Eligibility is tied to several consumer-protection and sustainability conditions. The state must limit premiums charged in the pool to no more than 200 percent of the applicable standard risk rate premium, ensuring the pool does not become effectively unaffordable. It also must offer a choice of two or more coverage options, meaning enrollees are not locked into a single plan design. Finally, the state must have a mechanism reasonably designed to ensure continued funding for losses after the last fiscal year covered by the grant. In other words, CMS is not only looking for proof that the pool lost money, but also for evidence that the state has a longer-term plan to keep the pool financially supported once federal grant dollars for that period end.
A key pricing-related rule applies to states with higher premium levels. If a qualified high risk pool charges premiums that exceed 150 percent of the applicable standard risk premium, the state must use at least 50 percent of its grant funds to reduce premiums for enrollees. This requirement pushes a substantial portion of the federal support directly toward lowering what people pay, rather than solely backfilling operational deficits, and it creates a clear incentive for states to improve affordability when premiums are especially elevated.
In addition to the primary grants for operational losses, CMS also made available "bonus" grants for supplemental consumer benefits. States already receiving an operational loss grant can apply for these additional funds to provide extra benefits to enrollees or potential enrollees (including specific subsets of those groups) in qualified high risk pools. While the notice does not list every possible supplemental benefit, the intent is to allow states to enhance what consumers receive beyond baseline pool coverage, targeting improvements where they are most needed.
Administratively, this opportunity was competitive, described as a competitive continuation for state high risk pools that already had an active CMS grant and had been awarded a no-cost extension beyond March 31, 2008. The program anticipated up to 32 awards, with an estimated total funding amount of $49,127,000. There was no stated award floor or ceiling in the summary data, and there was no cost sharing or matching requirement. The opportunity was posted April 4, 2008, with an application closing date of June 9, 2008, and it was archived July 9, 2008. The CFDA number associated with this program is 93.780 (Grants to States for Operation of Qualified High Risk Pools). For further details and official materials, CMS pointed applicants to its high risk pools webpage and provided a contact at CMS (Louise Amburgey, Louise.Amburgey@cms.hhs.gov) for access issues related to the full announcement.
Frequently Asked Questions (FAQs)
What is the Operational Grants to States for High Risk Pools opportunity (HHS-2008-CMS-HRP-0004)?
This is a CMS discretionary grant program designed to help states cover the operating losses of qualified state high risk health insurance pools. The goal is to stabilize these pools so they can keep offering coverage to people considered high risk who often have difficulty obtaining insurance in the broader market.
What is the main purpose of the funding?
The funding is intended to offset documented financial losses tied to operating an eligible high risk pool. It is not structured to pay for start-up costs or broad program expansion.
Where does the program's funding authority come from?
The funds come from appropriations authorized under section 2745(d)(1)(B) of the Public Health Service (PHS) Act.
Who is eligible to apply for this grant?
Eligibility is for states that operate a "qualified high risk pool" as defined in sections 2744(c)(2) and 2745(g) of the PHS Act, and that can demonstrate the pool incurred losses during the relevant period with sufficient documentation.
What does it mean to operate a "qualified high risk pool" for this program?
In practical terms, the pool must make coverage available to all eligible individuals without imposing a preexisting condition exclusion. The state may use an acceptable alternative enrollment mechanism, as long as a high risk pool is part of that mechanism. The pool must also set premium rates and covered benefits consistent with standards in the NAIC Model Health Plan for Uninsurable Individuals Act in effect when HIPAA was enacted (August 21, 1996).
Are states required to show financial losses to receive an operational grant?
Yes. Beyond meeting the statutory definition of a qualified high risk pool, a state must show that the pool actually incurred losses during the relevant period and provide enough documentation to substantiate those losses.
What consumer-protection conditions apply to eligibility?
The state must limit premiums charged in the pool to no more than 200 percent of the applicable standard risk rate premium, and it must offer a choice of two or more coverage options.
Is there a long-term funding expectation after the grant period ends?
Yes. The state must have a mechanism reasonably designed to ensure continued funding for losses after the last fiscal year covered by the grant. CMS is looking for evidence of a longer-term plan to keep the pool financially supported once federal grant dollars for that period end.
What is the maximum premium level allowed for a qualified pool under this opportunity?
The state must limit premiums in the pool to no more than 200 percent of the applicable standard risk rate premium.
What happens if the pool's premiums exceed 150 percent of the standard risk premium?
If a qualified high risk pool charges premiums that exceed 150 percent of the applicable standard risk premium, the state must use at least 50 percent of its grant funds to reduce premiums for enrollees.
Does the program require grant funds to be used for premium reduction in some cases?
Yes. When premiums exceed 150 percent of the applicable standard risk premium, at least 50 percent of grant funds must be used to reduce premiums for enrollees.
Does this grant pay for start-up costs or expansion of a high risk pool?
No. The program is structured around offsetting documented operating losses for an eligible pool, rather than covering start-up costs or general program expansion.
Are there additional ("bonus") grants available beyond operational loss grants?
Yes. CMS also made available bonus grants for supplemental consumer benefits. States already receiving an operational loss grant can apply for these additional funds.
Who can apply for the bonus grants?
States that are already receiving an operational loss grant may apply for bonus grant funds to provide supplemental consumer benefits.
What can bonus grant funds be used for?
Bonus grant funds can be used to provide additional benefits to enrollees or potential enrollees (including specific subsets of those groups) in qualified high risk pools, with the intent of enhancing what consumers receive beyond baseline pool coverage.
Was this opportunity competitive?
Yes. It was described as competitive and specifically as a competitive continuation for state high risk pools that already had an active CMS grant and had been awarded a no-cost extension beyond March 31, 2008.
How many awards were anticipated and what was the estimated total funding?
The program anticipated up to 32 awards, with an estimated total funding amount of $49,127,000.
Was there an award floor or ceiling listed?
No award floor or ceiling was stated in the summary data provided.
Is cost sharing or matching required?
No. There was no cost sharing or matching requirement.
What is the CFDA number for this program?
The CFDA number associated with this program is 93.780 (Grants to States for Operation of Qualified High Risk Pools).
When was the opportunity posted and when did it close?
The opportunity was posted on April 4, 2008, and the application closing date was June 9, 2008.
When was the opportunity archived?
The opportunity was archived on July 9, 2008.
Where did CMS direct applicants to find more details and official materials?
CMS pointed applicants to its high risk pools webpage for further details and official materials.
Who was the CMS contact listed for access issues related to the full announcement?
The contact listed was Louise Amburgey at CMS (Louise.Amburgey@cms.hhs.gov).
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