On July 27, 2010, DHHS issued a set of Questions and Answers on enrollment of children under 19 under the new policy that prohibits pre-existing condition exclusions.  Responding to concerns that some insurers may stop offering children-only policies as a result of the new ban on pre-existing exclusions, the administration clarified in the issuance that plans may restrict enrollment of children under 19, whether in family or individual coverage, to specific open enrollment periods in accordance with state law. In response to the question, “How often must an issuer in the individual market provide an open enrollment period for children under 19?”, the issuance states, “Unless State laws provide such guidance, issuers in the individual market may determine the number and length of open enrollment periods for children under 19 (as well as those for families and adults). The Administration, in partnership with States, will monitor the implementation of the pre-existing condition exclusion policy for children and issue further guidance on open enrollment periods if it appears that their use is limiting the access intended under the law”.  The issuance clarified that State law dealing with open enrollment periods is not preempted by any current Federal requirements.  The issuance also noted that while “Premium assistance” programs in CHIP allow States to provide payment to private policies to cover children if doing so both protects children and is cost effective to the Federal and State governments, “Premium assistance is not designed as a strategy to transfer vulnerable children to individual market coverage”. 

About Sam Fish

Sam Fish has over 40 years of legal experience in federal and state human services laws and programs, having joined PCG in 1995 after serving as Chief Counsel, Region I, for the U.S. Department of Health and Human Services for more than 25 years. At PCG, Sam provides legal advice and counsel and has served on many projects that required legal research and interpretation and implementation of many federal and state laws. He has also participated in in-house training in new litigation areas, including Temporary Assistance for Needy Families (TANF), the Balanced Budget Act (BBA), and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). He is available for legal guidance in program areas including school-based billing, third-party liability, Olmstead implementation, and Medicare and Medicaid reimbursement. Currently, he is providing guidance and counsel in the interpretation and implementation of the new health care legislation.

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