The following states have risk pools that remain operational as of 2023. Some of them are still accepting new members, although enrollees would have to meet the existing eligibility guidelines (note that some of these high-risk pools are still operational in order to provide supplemental coverage to disabled Medicare beneficiaries under the age of 65 in states where they do not have access to Medigap plans): Alaska (2023 rates) California (2022 rates; in 2015, coverage still had lifetime and annual benefit maximums, so enrollees could be subject to the ACA’s penalty for not maintaining minimum essential coverage; that issue was fixed by 2016 however, and MRMIP now provides minimum essential coverage). Idaho (no longer available for consumers to purchase, but still operational as a reinsurance program for the state’s insurers) Iowa (2023 rates) Nebraska (the pool currently only provides supplemental coverage for Medicare enrollees who are under age 65). New Mexico (membership had dropped to under 3,000 by 2020, from a high of more than 10,000, although NMMIP continues to offer coverage, they are working towards a “depopulation” goal, and encouraging members to seek coverage under Centennial Care or a QHP in the exchange) North Dakota (2022/2023 rates) (legislation — S.B.2158 — is under consideration in 2023 that would terminate North Dakota’s high-risk pool; the bill passed unanimously in the Senate soon after it was introduced) South Carolina Washington (non-Medicare coverage closed to new enrollees at the end of 2021. And since January 2014, new enrollments in non-Medicare coverage were only permitted if there was no ACA-compliant individual market plan available in the applicant’s county, and that has not been the case anywhere in Washington) Wyoming (the pool currently only provides supplemental coverage for Medicare enrollees who are under age 65).