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Section 1331 of the Affordable Care Act offers states the alternative of developing a Basic Health Program (BHP), a health advantages coverage program for low-income locals who would otherwise be qualified to purchase coverage through the Health Insurance Marketplace. The Basic Health Program gives states the capability to provide more economical protection for these low-income locals and improve continuity of look after people whose earnings 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 residents or lawfully present non-citizens, who do not certify for Medicaid, CHIP, or other minimum important coverage and have earnings between 133 percent and 200 percent of the federal hardship level (FPL). People who are legally present non-citizens who have income that does not go beyond 133 percent of FPL but who are unable to get approved for Medicaid due to such non-citizen status, are also eligible to enlist.

Consistent with the statute, advantages will consist of at least the ten essential health advantages defined in the Affordable Care Act. The regular monthly premium and cost sharing charged to qualified individuals will not surpass what a qualified individual would have paid if she or he were to get coverage from a certified health insurance (QHP) through the Marketplace. A state that operates a Basic Health Program will get federal funding equal to 95 percent of the quantity of the premium tax credits and the cost sharing decreases that would have otherwise been provided to (or on behalf of) eligible people if these people enrolled in QHPs through the Marketplace.

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

Basic Health Program Blueprint

The Basic Health Program Blueprint is the kind that states need to utilize 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 design options of the state and to provide a full description of the operations and management of the program and its compliance with the federal guidelines.

Oregon's Basic Health Program Blueprint June 2024

New york city's Basic Health Program Suspension Approval Letter March 2024.

New york city's Basic Health Program Suspension Application March 2024.

New York'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 between the Basic Health Program and other insurance coverage affordability programs, rather than establish brand-new and various rules for the Basic Health Program, we have actually aligned, when possible, Basic Health Program rules with existing guidelines 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 Funding Methodology

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

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 Health Insurance Exchange Premiums collects info from states running State Based Exchanges to support the determination of federal payment to states that choose to develop a Basic Health Program.

State Report for Medical Insurance Exchange Premiums October 2014


Basic Health Program Implementation Experiences

This discussion describes the preparation and implementation experiences of New york city and Minnesota, following their first months operating the BHP. It supplies a summary of the BHP, followed by a description and crucial findings stemming from each state's approach to program administration, financing, target populations, and contracting choices.