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Basic Health Program

Section 1331 of the Affordable Care Act gives states the option of creating a Basic Health Program (BHP), a health benefits coverage program for low-income residents who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace. The Basic Health Program gives states the ability to provide more affordable coverage for these low-income residents and improve continuity of care for people whose income fluctuates above and below Medicaid and Children's Health Insurance Program (CHIP) levels.

Through the Basic Health Program, states can provide coverage to individuals who are citizens or lawfully present non-citizens, who do not qualify for Medicaid, CHIP, or other minimum essential coverage and have income between 133 percent and 200 percent of the federal poverty level (FPL). People who are lawfully present non-citizens who have income that does not exceed 133 percent of FPL but who are unable to qualify for Medicaid due to such non-citizen status, are also eligible to enroll.

Consistent with the statute, benefits will include at least the ten essential health benefits specified in the Affordable Care Act. The monthly premium and cost sharing charged to eligible individuals will not exceed what an eligible individual would have paid if he or she were to receive coverage from a qualified health plan (QHP) through the Marketplace. A state that operates a Basic Health Program will receive federal funding equal to 95 percent of the amount of the premium tax credits and the cost sharing reductions that would have otherwise been provided to (or on behalf of) eligible individuals if these individuals enrolled in QHPs through the Marketplace.

Minnesota has implemented a Basic Health Program since January 1, 2015. New York has implemented a Basic Health Program since April 1, 2015 and will suspend its implementation on April 1, 2024.

Basic Health Program Blueprint

The Basic Health Program Blueprint is the form that states must use to make an official request for certification of a Basic Health Program as set forth in 42 CFR 600.110. The Blueprint is intended to collect the program design choices of the state and to provide a full description of the operations and management of the program and its compliance with the federal rules. 

Federal Guidance

Notice of Proposed Rulemaking and Final Rule

To promote coordination between the Basic Health Program and other insurance affordability programs, rather than establish new and different rules for the Basic Health Program, we have aligned, when possible, Basic Health Program rules with existing rules governing coverage through the Marketplace, Medicaid, or CHIP.

Federal Funding Methodology

The methodology documents provide the methodology necessary to determine federal payment amounts made to states that elect to establish a Basic Health Program.

State Report for Health Insurance Exchange Premiums

The State Report for Health Insurance Exchange Premiums collects information from states operating State Based Exchanges to support the determination of federal payment amounts to states that elect to establish a Basic Health Program.

Basic Health Program Implementation Experiences

This presentation describes the planning and implementation experiences of New York and Minnesota, following their first months operating the BHP. It provides an overview of the BHP, followed by a description and key findings stemming from each state’s approach to program administration, financing, target populations, and contracting decisions.