The U.S. Department of Health and Human Services (HHS) released a letter to Governors and insurance commissioners on April 2 asking for state decisions on whether, and exactly how, they will participate in a $5 billion high risk pool program created under the health care reform law to offer immediate health insurance coverage for persons who have been denied coverage due to pre-existing conditions.   There are a range of options for states, from building on the state high risk pools that many states have already created, to taking no additional action, in which case HHS will contract directly for insurance coverage for qualifying individuals.  HHS has asked states to analyze the options and reply by April 30.