Section 1331 of the Affordable Care Act gives states the alternative of producing a Basic Health Program (BHP), a health benefits coverage program for low-income homeowners who would otherwise be eligible to purchase coverage through the Medical insurance Marketplace. The Basic Health Program provides states the ability to offer more inexpensive protection for these low-income residents and enhance continuity of look after individuals whose income changes above and listed below Medicaid and Children's Medical insurance Program (CHIP) levels.
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Through the Basic Health Program, states can offer protection to individuals who are residents or lawfully present non-citizens, who do not get approved for Medicaid, CHIP, or other minimum essential protection and have earnings in between 133 percent and 200 percent of the federal poverty level (FPL). People who are legally present non-citizens who have earnings that does not go beyond 133 percent of FPL but who are not able to certify for Medicaid due to such non-citizen status, are likewise qualified to enlist.

Consistent with the statute, advantages will include a minimum of the 10 necessary health advantages defined in the Affordable Care Act. The month-to-month premium and cost sharing credited qualified people will not surpass what an eligible individual would have paid if she or he were to receive coverage from a qualified health strategy (QHP) through the Marketplace. A state that operates a Basic Health Program will receive federal financing equivalent to 95 percent of the quantity of the premium tax credits and the expense sharing reductions that would have otherwise been supplied to (or on behalf of) qualified individuals if these people registered in QHPs through the Marketplace.

Minnesota has actually carried out a Basic Health Program since January 1, 2015. Oregon received approval for a Basic Health Program on June 7, 2024 and will implement on July 1, 2024 New york city had actually executed a Basic Health Program given that April 1, 2015 and suspended its implementation on April 1, 2024

Basic Health Program Blueprint

The Basic Health Program Blueprint is the form that states need to use to make a main request for accreditation of a Basic Health Program as stated in 42 CFR 600.110. The Blueprint is planned to collect the program style choices of the state and to offer a full description of the operations and management of the program and its compliance with the federal rules.

Oregon's Basic Health Program Blueprint June 2024
New York's Basic Health Program Suspension Approval Letter March 2024.
New york city's Basic Health Program Suspension Application March 2024.
New york city's Basic Health Program Blueprint May 2023
Minnesota's Basic Health Program Blueprint December 2022
Federal Guidance

Notice of Proposed Rulemaking and Final Rule

To promote coordination in between the Basic Health Program and other insurance price programs, rather than establish brand-new and different guidelines for the Basic Health Program, we have lined up, when possible, Basic Health Program rules with existing rules governing protection through the Marketplace, Medicaid, or CHIP.

Final Rule March 2014
Fact Sheet on Final Rule March 2014
Basic Health Program Frequently Asked Questions May 8, 2014
Basic Health Program Summary NPRM Overview November 2013
Notice of Proposed Rulemaking September 2013
Fact Sheet on Notice of Proposed Rulemaking September 2013
Federal Methodology

The approach documents supply the approach necessary to determine federal payment quantities made to states that choose to establish a Basic Health Program.
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Basic Health Program; Federal Funding Methodology for Program Year 2025 August 21, 2024
Basic Health Program; Federal Funding Methodology for Program Year 2024 September 15, 2023
Basic Health Program: Federal Funding Methodology for Program Year 2023 Final Rule December 20, 2022
Basic Health Program Funding Methodology Final Payment Notice for Program Year 2022 July 2, 2021
Basic Health Program Funding Methodology Proposed Payment Notice for Program Year 2022 October 30, 2020
Basic Health Program Funding Methodology Final Payment Notice for Program Year 2021 August 10, 2020
Basic Health Program Funding Methodology Proposed Payment Notice for Program Year 2021 February 6, 2020
Basic Health Program Funding Methodology Final Notice for Program Years 2019 and 2020 November 1, 2019
Final Administrative Order for 2018 Revised Payment Methodology August 2018
Basic Health Program; Federal Funding Methodology for Program Year 2018 May 2017
Final 2017 and 2018 Payment Notice February 2016
Final 2016 Payment Notice February 2015
Risk Adjustment and BHP June 2014
Final 2015 Payment Notice March 2014
Fact Sheet on Final 2015 Payment Notice and Final Rule March 2014
State Report for Medical Insurance Exchange Premiums

The State Report for Medical Insurance Exchange Premiums gathers info from states operating State Based Exchanges to support the determination of federal payment total up to states that elect to develop a Basic Health Program.

State Report for Medical Insurance Exchange Premiums October 2014
Basic Health Program Implementation Experiences

This presentation describes the planning and execution experiences of New York and Minnesota, following their first months running the BHP. It provides a summary of the BHP, followed by a description and key findings stemming from each state's method to program administration, financing, target populations, and contracting decisions.