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How State Lists Of Health Conditions Can Help Insurance Seekers

The special health plans that were created under the overhaul law for people with preexisting medical conditions are up and running now.

Some people who could benefit from them are having a tough time qualifying, though. Not only do applicants have to be uninsured for at least six months, in most states they have to prove that they’ve been turned down for private insurance coverage.

But in 23 states, there's a way around the denial requirement. In these states, anyone who has one of a number of specified medical conditions is automatically eligible for the Preexisting Condition Insurance Plan.

State "condition lists," as they’re called, vary. Several illnesses like Parkinson's disease, HIV/AIDS, diabetes and multiple sclerosis are almost certain to appear. But in other cases, states have made more unexpected choices.

For example, Alaska's list covers more than 60 conditions, including morbid obesity. In Colorado, 34 conditions qualify, including panic disorder and anorexia. "There’s a striking amount of variation in the plans," says Jean Hall, an associate research professor at the University of Kansas and co-author of a recent report on the new plans.

Most states cover cancer in some fashion, though some specify that it must be metastatic cancer (cancer that has spread to other parts of the body), or that someone have had a malignant tumor in the past four years. That's a catch that can trip up many cancer patients.

When health overhaul became law, states had the option of running their own PCIP program or letting the federal government do it. None of the plans adminstered by the federal government in 23 states and the District of Columbia —including Virginia-- use condition lists.

But of the 27 states that chose to run their own program, 23 have opted to use condition lists to help determine eligibility.

Copyright 2023 Kaiser Health News. To see more, visit Kaiser Health News.

Michelle Andrews