Note: An update to this topic was published on July 3, 2013.


Beginning January 1, 2014, the Patient Protection and Affordable Care Act (ACA) will prohibit health insurers from denying coverage or limiting benefits for people with pre-existing conditions. Coverage through any insurance company will be guaranteed.

Pre-Ex Coverage Prior to 2014
To help individuals with serious health conditions obtain coverage prior to 2014, the ACA also created a temporary national high-risk pool to provide health coverage for adults with preexisting conditions called the Pre-Existing Conditions Insurance Plan (PCIP). The PCIP will be operational from August 1, 2010 to January 1, 2014, but has stopped accepting new enrollment as of February 15, 2013, to make way for the new health insurance exchanges that will operate in each state beginning January 1, 2014.

Minnesota has provided guaranteed coverage to individuals with serious health conditions since 1976. The Minnesota Comprehensive Health Association (MCHA) is a state-based high-risk pool currently administered by Medica that offers coverage to Minnesota residents who are turned down for coverage in the private market based on health history. MCHA currently has about 26,000 members and is the largest high-risk pool in the country.

At the current time, people who can’t get insurance because of pre-existing conditions will be able to join MCHA. MCHA does not have a waiting period before coverage becomes effective, but it does exclude from coverage any pre-existing conditions of the enrollee for the first six months. MCHA will continue to operate until at least January 1, 2014.

Pre-Ex Coverage After January 1, 2014
The future of MCHA after January 1, 2014 is uncertain. In a market where coverage by insurance companies is guaranteed, the primary need for a state high-risk pool goes away.

The State Health Access Data Assistance Center (SHADAC) at the University of Minnesota has stated that the potential is high for individuals currently covered by MCHA to move to Medicaid and the individual market in 2014. SHADAC further estimated that 58% of MCHA enrollees would be eligible for some form of subsidized health insurance at that time, through the expansion of Medicaid, a Basic Health Program, or premium subsidies and cost-sharing reductions available from the federal government for qualifying individuals who purchase coverage through the exchange.