TRENTON — The Christie Administration announced today that the United States Department of Health and Human Services (HHS) has awarded New Jersey a $22.6-million contract to continue operating NJ Protect, the State’s health insurance program for individuals with pre-existing conditions, from June through the end of the year. As a result, the 1,520 people currently enrolled in the State–operated program can maintain their doctors and provider networks, current coverage and will not see an increase in their premiums this year.
“This is good news for New Jersey residents who will continue to be served by our State-operated program and keep their existing doctors, healthcare provider networks, health plans, and also can be assured that their premiums will not rise for the remainder of the year,” said New Jersey Department of Banking and Insurance (DOBI) Commissioner Ken Kobylowski.
Pre-existing Condition Insurance Plans (PCIPs) were created in all states in 2010. The program was open to individuals with pre-existing illnesses, such as cancer, heart disease, and diabetes, who had not had health insurance for six months. States had the option of operating their own PCIPs or letting the federal government run the program. New Jersey introduced its State-operated PCIP in August 2010.
In February, HHS informed PCIP contractors in all states to cease accepting new enrollment within 15 days. As a result, the final date that consumers could submit new applications for NJ Protect was March 1. Commissioner Kobylowski subsequently sent a letter to HHS Secretary Sebelius requesting that she reconsider the ban on new enrollees, which HHS declined.
HHS then informed PCIP contractors that they would have to accept a fixed budget for the balance of the year or turn the program over to the Federal PCIP. As a result, 17 states which chose to operate their own PCIPs have decided to allow them to be federally-run for the remainder of 2013. Shifting from a state- to a federally- run PCIP would potentially force consumers in those states to switch doctors and healthcare networks, and face plan changes and premium increases.
New Jersey has worked with its PCIP carriers to continue operating its own PCIP program, rather than allow it to default to a federally operated program. The two insurance carriers that have been participating in NJ Protect, AmeriHealth New Jersey and Horizon Blue Cross Blue Shield of NJ were willing partners in continuing with the State-run PCIP.
“We felt very strongly that the State and its New Jersey carriers could do a better job running the program,” continued Commissioner Kobylowski. “New Jersey’s program has operated far more efficiently than many other states’ PCIP programs. Also, by keeping the program in New Jersey, we were ensuring that those enrolled in NJ Protect could keep their doctors and provider networks. We could not have done it without the help of our NJ Protect carriers, Horizon and AmeriHealth. Those two carriers have been excellent partners in this program.”
When the $5-billion PCIP program was created three years ago, New Jersey was originally allocated $141 million to run its program from August 2010 through the end of 2013, when the PCIP program is set to expire. To date New Jersey has spent approximately $75 million of these funds and anticipated spending less than the $141 million allocation, while many other states programs exceeded their budgets, forcing the national shutdown of enrollment in March.
NJ Protect operates through a contract between the New Jersey Individual Health Coverage Program Board and the U.S. Department of Health & Human Services.