Grants boost S.D. insurance risk pool

South Dakota's insurance risk pool recently received federal dollars aimed at helping people in the system maintain their health.

The state this year applied for two federal grants totaling almost $725,000 and will use the money to help defray costs of the program and to establish a vaccination program for people in the risk pool. South Dakota is one of 30 states receiving a portion of $49 million in grants.

"We think it's going to make good sense in the long run," said Randy Moses, assistant director of the South Dakota Division of Insurance.

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Established in 2003, the risk pool is meant to be a safety net for people who have lost their health insurance through no fault of their own and aren't able to get another policy. The risk pool is funded largely by the state and the dozen firms licensed in the state to underwrite health insurance policies. The companies pay 25 cents per member per month to pay for the pool.

Currently, 672 people are enrolled in the risk pool. That's down about 50 people from this time last year, Moses said.

"We kind of predicted there would be some plateauing of it," he said.

The immunization program partially funded by the $208,600 federal grant will pay for preventive vaccines, such as flu shots, for people in the risk pool. It's meant to help keep people in the pool - who usually have health problems - healthier, Moses said.

The other grant, for $516,009, will help pay for losses incurred by the state to operate this risk pool, Moses said. The state kicked in about $650,000 last year.

To be eligible, state residents must apply within 63 days of losing prior coverage, have had at least 12 months of continuous credited coverage, have used up COBRA or state continuation coverage, have not lost their most recent coverage because of nonpayment of premiums or fraud, and not be eligible for Medicare, Medicaid or a group health plan.

"Individuals who benefit from these pools usually have a history of health problems that make it extremely difficult to find affordable health coverage in the individual market," Michael Leavitt, secretary of the U.S. Department of Health and Human Services, said in a statement.

More than 200,000 people are enrolled in state risk pools nationwide, according to HHS.

The risk pool fills a temporary need, but a recent state health task force found that another risk pool for long-term uninsurable South Dakotans might be needed. The Zaniya Task Force concluded last year that about 5,200 people in the state might qualify for such a risk pool that could help people receive preventive care.

"One of the underlying precepts we have with Zaniya is everyone deserves timely and appropriate health care, and you don't get that when the only health care that you get is through an emergency room," said State Sen. Tom Dempster, R-Sioux Falls, who helped spearhead the task force.

Reach Megan Myers at 331-2257.