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 and New York have implemented Basic Health Programs, with Minnesota’s program beginning January 1, 2015, and New York’s program beginning April 1, 2015.
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.
- New York's Basic Health Program Blueprint (PDF, 277.61 KB) May 2021
- Basic Health Program Blueprint (PDF, 280.64 KB) May 2021
- Minnesota's Basic Health Program Blueprint (PDF, 612.97 KB) January 2017
- Minnesota’s Basic Health Program Blueprint Revisions Summary (PDF, 200.88 KB) January 2017
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.
- Final Rule March 2014
- Fact Sheet on Final Rule (PDF, 293.51 KB) March 2014
- Basic Health Program Frequently Asked Questions (PDF, 209.76 KB) May 8, 2014
- Basic Health Program Summary NPRM Overview (PDF, 404.64 KB) November 2013
- Notice of Proposed Rulemaking September 2013
- Fact Sheet on Notice of Proposed Rulemaking September 2013
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.
- 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 (PDF, 172.57 KB) 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 (PDF, 153.39 KB) June 2014
- Final 2015 Payment Notice March 2014
- Fact Sheet on Final 2015 Payment Notice and Final Rule (PDF, 293.51 KB) March 2014
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.
- State Report for Health Insurance Exchange Premiums (ZIP, 36.46 KB) October 2014
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.
- Basic Health Program Implementation Experiences (PDF, 426.99 KB) September 2015