Federal Government will Manage Utah’s High-Risk Health Insurance Pool

May 21, 2013

Many Utahns with preexisting medical conditions will see their health insurance shifted from state to federal oversight in July. After federal funding ran short for the “high-risk” insurance pool, state officials have refused to take on any additional costs. And federal health officials have refused to allow Select Health, the insurer that administers the program for Utah, to take responsibility. 

Utah has been administering the high-risk insurance pool with federal dollars since 2010. But when the federal government announced they were running out of funding, they gave states two options - take over the risk of additional costs themselves or return the program to federal oversight.  Utah’s Governor Gary Herbert proposed a third option - for SelectHealth, the insurer that administers the program for Utah, to take over and assume the risk. But the federal government refused, citing concerns about the ability to pay a third party. Robert Spendlove, the Utah Governor’s Deputy for Federal Relations, says that ties the state’s hands.  

“It’s really disappointing because the state – we can do a much better job than the federal government can,” Spendlove says. “We have existing contracts. We know how to do this. We know how to serve this population. Now, because of the federal government’s refusal to be flexible, we’re going to have to shift these from a state program to a federal program by July 1.”

Spendlove says those in the high-risk pool won’t lose coverage, but they may have to pay more in premiums and out-of-pocket costs, and may experience disruptions or reductions in service.  The program is set to expire in 2014, when insurance companies can no longer deny coverage to those with preexisting medical conditions.