Grants to States for Operation of Qualified High-Risk Pools

To assist States in the operation of a qualified high-risk health insurance pool by providing Federal funding (for up to appropriate funding levels) of losses incurred by the pool for a given State fiscal year.

Agency - Department of Health and Human Services

The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.

Office - See Regional Agency Offices.

Contact the appropriate CMS Regional Administrator.

(See appendix IV for Regional Offices).

Selected Recipients for this Program

RecipientAmount Start DateEnd Date
Missouri Health Insurance Pool $ 9,693,255   2008-07-012019-09-30
South Carolina Health Insurance Pool $ 9,559,906   2008-07-012015-12-31
Health & Family Services, Kentucky Cabinet For $ 1,424,047   2013-08-232015-09-29
Oregon Health Authority Directors Office Financial Services $ 4,978,000   2012-03-092015-09-29
Louisiana High Risk Health Pool, Inc $ 9,184,212   2006-09-302015-09-29
Utah Comprehensive Health Insurance Pool $ 8,437,314   2005-09-302015-09-29
Indiana Comprehensive Health Insurance Association $ 7,354,683   2004-01-012015-09-29
Comprehensive Health Insurance Risk Pool Association $ 5,872,183   2004-01-012015-09-29
Nebraska Department Of Insurance $ 4,179,409   2004-01-012015-09-29
Oklahoma Health Insurance High Risk Pool $ 5,648,549   2004-01-012015-09-29

Program Accomplishments

Not Applicable.

Uses and Use Restrictions

A State must have a qualified high-risk pool (as defined in section 2744(c)(2) of the Public Health Service Act) that has incurred a loss in order to be eligible for a grant.

Eligibility Requirements

Applicant Eligibility

A State must meet all of the following requirements to be eligible for a grant: 1) the State is operating a qualified high-risk pool as defined in section 2744(c)(2) of the Public Health Service Act; 2) the pool restricts premium charged under the pool to no more than 200 percent for applicable standard risk rates for the State; 3) the pool offers a choice of two or more coverage options through the pool; 4) the pool has in effect a mechanism reasonably designed to ensure continued funding of losses incurred by the State; and 5) Grant Awards: FY 2012 - The Consolidated Appropriations Act, 2012.

(Public Law 112-74), provided $43.197 million to 31 States; FY 2013 - The Consolidated and Continuing Appropriations Act, 2013 (Public Law 113-6), which provided $41.756 million to 31 States; and in FY 2014 - The Consolidated Appropriations Act, 2014 (Public Law 113-76), which provided $20.419 million to only 26 States.

It must be noted, the State High Risk Pool Grant Program officially ends on 09/30/2015.

All States which received an award between FY 2012 and FY 2014 were federally qualified States currently receiving a HRP Grant award as a supplemental (extension) award to their 2008 Operational Losses.

Beneficiary Eligibility

State Agency.


Federal funds must go to a designated State Agency or its partner agencies. Individuals must meet State requirements. This program is excluded from coverage under 2 CFR 200, Subpart E - Cost Principles.

Aplication and Award Process

Preapplication Coordination

Preapplication coordination is required.

Environmental impact information is not required for this program.

This program is excluded from coverage under E.O.


Application Procedures

2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. The standard application form SF-424 and related forms, as furnished by CMS, must be used for this program. These forms may be downloaded from the following Web site, In addition to the standard forms some additional information regarding the history and description of the qualified high-risk pool, accounting of risk pool losses, and contact person information is also required. Please refer to the following Web site for additional information: Applicants are required to submit an original and two copies of the application to the Gabriel Nah, Grants Management Specialist, (, Centers for Medicare and Medicaid Services (CMS, Office of Acquisition and Grants Management (OAGM) 200 Independence Ave., S.W., Room 739H, Washington, DC 20201

Award Procedures

The Centers for Medicare and Medicaid Services (CMS) will make a decision for each application received. Each applicant will receive written notification of CMS's decision. Applicants approved for a grant award must submit a letter of acceptance to CMS within 30 days of the date of the award, agreeing to the terms and conditions of the award letter.


Contact the headquarters or regional office, as appropriate, for application deadlines.


Trade Act of 2002; (Public Law 107-210); Deficit Reduction Act of 2005; (Public Law 109-171); Public Law (109-172), Executive Order State High Risk Pool Funding Extension Act of 2006, Public Law 109-171.

Range of Approval/Disapproval Time

60 to 120 days.


If an application is disapproved, the reasons for disapproval will be fully stated.



Assistance Considerations

Formula and Matching Requirements

Statutory formulas are not applicable to this program. This program has no matching requirements. This program does not have MOE requirements.

Length and Time Phasing of Assistance

Under the original legislation, a total of $80,000,000 has been made available for the qualified high-risk pool operation grant program. $40,000,000 was made available for obligation from FY 2003-FY 2004 and another $40,000,000 was made available for obligation from FY 2004-FY 2005. Under the provisions of section 6202 of the Deficit reduction Act, $75,000,000 was made available in FY 2006 for this activity. The Consolidated Appropriations Act of 2008 made available $49,126,500. The Omnibus Appropriations Act of 2009 made available $75,000,000. The Consolidated Appropriations Act of 2010 made available $55,000,000. Sections 1119 and 1818 of the Full-Year Continuing Appropriations Act, 2011 authorized $54,890,000. The Consolidated Appropriations Act of 2012 made available $44,000,000. Method of awarding/releasing assistance: lump sum.

Post Assistance Requirements


No program reports are required.

No cash reports are required.

No progress reports are required.

Grant awardees may be required to submit quarterly progress and financial reports to CMS.

At a maximum, a grantee would have to complete 8 reports per year if requested.

It is anticipated that grantees may only need to file semi-annually, thus 4 reports per year.

Refer to 45 CFR part 92.

No performance monitoring is required.


In accordance with the provisions of 2 CFR 200, Subpart F - Audit Requirements, non-Federal entities that expend financial assistance of $750,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Non-Federal entities that expend less than $750,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in 2 CFR 200.503. All fiscal transactions identifiable to Federal financial assistance are subject to audit by DHHS audit agency.


Proper accounting records, identifiable by project number and including all receipts and expenditures, must be maintained for 3 years. Subsequent to audit, they must be maintained until all questions are resolved.

Financial Information

Account Identification



(Formula Grants (Apportionments)) FY 16 $0; FY 17 est $0; and FY 18 est $0 - FY 2014 was the last year for CMS to request State HRP funding from the Program Management account, because of the initiation of the Marketplaces.

Range and Average of Financial Assistance


Regulations, Guidelines, and Literature

Grants Administration policies (45 CFR 74 and 92) application kits may be obtained from the Acquisition and Grants Group, CMS, Mailstop C2-21-15, 7500 Security Boulevard, Baltimore, MD 21244-1850. The grant application kit may be downloaded from the following web site,

Information Contacts

Regional or Local Office

See Regional Agency Offices. Contact the appropriate CMS Regional Administrator. (See appendix IV for Regional Offices).

Headquarters Office

Gabriel Nah 200 Independence Ave., S.W., Room 739H, Washington, District of Columbia 20201 Email: Phone: (301) 492-4482

Criteria for Selecting Proposals

Each application will be reviewed to ensure it meets the eligibility criteria (as stated above). If eligible, the State will be awarded the lesser 50 percent of losses incurred by its qualified risk pool for the fiscal year in question or its allotment under the formula for the grants.

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