Opportunity Information: Apply for HHS 2009 CMS HRP 0004
Apply for HHS 2009 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 May 14, 2009 and posted on May 14, 2009.
- Applicants must submit their applications by Jun 30, 2009 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 $1,500,000.00 to eligible and selected applicants.
- Each selected applicant is eligible to receive up to $1,500,000.00 in funding.
- The number of recipients for this funding is limited to 1 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 that do not have an active CMS Operational Losses grant beyond March 31, 2009. 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 (Funding Opportunity Number HHS 2009 CMS HRP 0004) is a competitive CMS grant program designed to help states cover operational losses incurred by qualified high risk health insurance pools. The funding is authorized under section 2745(d)(1)(B) of the Public Health Service Act and is aimed specifically at supporting the day-to-day financial shortfalls that can occur when high risk pools provide coverage to individuals who are medically uninsurable or otherwise face significant barriers in the private market. In practical terms, the grant is meant to offset losses from running a qualifying pool rather than to fund new construction, research, or unrelated health initiatives.
This opportunity was posted on May 14, 2009, with an application closing date of June 30, 2009, and an archive date of July 30, 2009. CMS anticipated making a single award under this announcement. The total estimated funding available was up to $1,500,000, and both the award floor and award ceiling were set at $1,500,000, indicating CMS expected one recipient to receive the full amount rather than splitting funds among multiple grantees. The program falls under CFDA 93.780 (Grants to States for Operation of Qualified High Risk Pools). There is no cost-sharing or matching requirement, which means applicants were not required to contribute a specific non-federal share as a condition of receiving the award.
Eligibility is narrow and targeted. It is a competitive opportunity for state high risk pools that do not have an active CMS Operational Losses grant extending beyond March 31, 2009. Applicants must be states with an established qualified high risk pool, and the pool must meet the statutory definition and standards referenced in sections 2744(c)(2) and 2745(g) of the PHS Act. The definition emphasizes broad access to coverage for eligible individuals without imposing preexisting condition exclusions, although enrollment can occur through an acceptable alternative mechanism as recognized under section 2744, as long as the high risk pool is a component of that mechanism. The pool must also align its premium rates and covered benefits with standards consistent with the NAIC Model Health Plan for Uninsurable Individuals Act as it existed when HIPAA was enacted on August 21, 1996, anchoring the program to an established model for how these pools should be structured and priced.
To qualify for funding, the state must demonstrate that the pool has incurred operational losses during the covered period and that key consumer and program integrity conditions are met. The pool must restrict premiums to no more than 200 percent of the premium for applicable standard risk rates, which is intended to keep coverage from becoming prohibitively expensive for high risk enrollees even though their expected claims are higher. The pool must offer a choice of two or more coverage options, reinforcing the expectation that enrollees have meaningful plan selection rather than being locked into a single design. In addition, the state must have a mechanism reasonably designed to ensure continued funding of the pool’s losses after the end of the last fiscal year supported by this grant, which functions as a sustainability requirement so that federal funds do not temporarily prop up a pool that lacks a plan for ongoing solvency.
Applications also needed to include sufficient documentation of losses incurred in operating the qualified high risk pool for the grant period. That documentation requirement is central to the program’s purpose: the grant is meant to reimburse or offset real operational deficits tied to providing coverage under qualifying rules, not projected losses without support or expenses unrelated to pool operations. Because the award is competitive, CMS would evaluate eligible applicants against one another rather than awarding funds automatically to every state that meets the baseline requirements.
The administering agency is the Centers for Medicare and Medicaid Services, and the funding instrument is a discretionary grant within the health activity category. The announcement directed applicants to the CMS High Risk Pools webpage for full details and provided a point of contact for access issues: Linda Gmeiner (Linda.Gmeiner@cms.hhs.gov).
Frequently Asked Questions (FAQs)
What is the "Operational Grants to States for High Risk Pools" opportunity?
This is a competitive CMS grant program intended to help states cover operational losses incurred by qualified high risk health insurance pools. It is focused on day-to-day financial shortfalls that can arise when high risk pools provide coverage to individuals who are medically uninsurable or otherwise face major barriers in the private insurance market.
What is the Funding Opportunity Number (FON) for this grant?
The Funding Opportunity Number is HHS 2009 CMS HRP 0004.
Which federal agency administers this grant?
The administering agency is the Centers for Medicare and Medicaid Services (CMS).
What is the legal authority for this funding?
The funding is authorized under section 2745(d)(1)(B) of the Public Health Service Act.
What is the CFDA number for this program?
The program falls under CFDA 93.780, titled "Grants to States for Operation of Qualified High Risk Pools."
What is the purpose of the grant funding?
The purpose is to offset or reimburse operational losses from running a qualifying high risk pool. The grant is aimed at covering operating deficits tied to providing coverage under qualifying rules and standards.
What is this grant NOT intended to fund?
Based on the description provided, the grant is not intended to fund new construction, research, or unrelated health initiatives. It is intended specifically for operational shortfalls (operational losses) of a qualified high risk pool.
Is this a competitive grant or an automatic formula award?
This is a competitive opportunity. CMS evaluates eligible applicants against one another rather than awarding funds automatically to every state that meets baseline requirements.
Who is eligible to apply?
Eligibility is limited to states with an established qualified high risk pool, and the pool must meet statutory definitions and standards referenced in sections 2744(c)(2) and 2745(g) of the Public Health Service Act.
Are all state high risk pools eligible?
No. The opportunity is targeted to state high risk pools that do not have an active CMS Operational Losses grant extending beyond March 31, 2009.
What does it mean for a pool to be "qualified" under this opportunity?
The pool must meet the statutory definition and standards referenced in sections 2744(c)(2) and 2745(g) of the Public Health Service Act. The definition emphasizes broad access to coverage for eligible individuals without imposing preexisting condition exclusions. Enrollment may occur through an acceptable alternative mechanism recognized under section 2744, as long as the high risk pool is a component of that mechanism.
Are there requirements for premium limits?
Yes. To qualify for funding, the pool must restrict premiums to no more than 200 percent of the premium for applicable standard risk rates.
Are there requirements related to benefit design or plan options?
Yes. The pool must offer a choice of two or more coverage options, which reflects an expectation that enrollees have meaningful plan selection.
Are there standards the pool must follow related to premium rates and covered benefits?
Yes. The pool must align its premium rates and covered benefits with standards consistent with the NAIC Model Health Plan for Uninsurable Individuals Act as it existed when HIPAA was enacted on August 21, 1996.
What is required regarding sustainability after the grant period ends?
The state must have a mechanism reasonably designed to ensure continued funding of the pool's losses after the end of the last fiscal year supported by this grant. This functions as a sustainability requirement so federal funds do not temporarily support a pool that lacks a plan for ongoing solvency.
What kinds of documentation are required in the application?
Applications needed to include sufficient documentation of losses incurred in operating the qualified high risk pool for the grant period. This documentation requirement supports the program purpose of offsetting real operational deficits tied to qualifying pool operations.
Does the grant cover projected losses or only incurred losses?
The description emphasizes documentation of losses incurred in operating the qualified high risk pool for the grant period, indicating the focus is on real operational deficits rather than unsupported projections or expenses unrelated to pool operations.
How many awards did CMS expect to make?
CMS anticipated making a single award under this announcement.
What is the total estimated funding available?
The total estimated funding available was up to $1,500,000.
What were the award floor and award ceiling?
Both the award floor and the award ceiling were set at $1,500,000, indicating CMS expected one recipient to receive the full amount rather than splitting funds among multiple grantees.
Is there a cost-sharing or matching requirement?
No. There is no cost-sharing or matching requirement for this opportunity.
What type of funding instrument is used?
The funding instrument is a discretionary grant.
What category does this program fall under?
The announcement identifies it within the health activity category.
When was the opportunity posted?
The opportunity was posted on May 14, 2009.
What was the application closing date?
The application closing date was June 30, 2009.
When was the archive date?
The archive date was July 30, 2009.
Where were applicants directed for full details?
The announcement directed applicants to the CMS High Risk Pools webpage for full details.
Who is the point of contact for access issues?
The point of contact listed for access issues is Linda Gmeiner at Linda.Gmeiner@cms.hhs.gov.
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