Basic Health Plan

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% and 200% of the federal poverty level (FPL). People who are lawfully present non-citizens who have income that does not exceed 133% 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% 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 is the first state to implement the Basic Health Program, with coverage beginning January 1, 2015.
Basic Health Program



Kaiser Foundation – The ACA’s Basic Health Program Option: Federal Requirements and State Trade-Offs

NPR – Few States Use Health Law Option For Low-Cost Plans

Robert Wood Johnson Foundation – The Basic Health Program Option under Federal Health Reform

State of Oregon – House Bill 2934

State of New York – Essential Plan Information

Georgetown University – Two States On the Path to the Basic Health Program

Minnesota Budget Project – The Basic Health Plan: The Next Generation of Minnesota Care

Minnesota Public Radio – Affordable Care Act has unique proving ground in Minnesota

Minnesota basic health plan blueprint

Families USA – Why Minnesota and New York Are Pursuing Basic Health Programs

Oregon Center for Public Policy – Basic Health Can Increase Health Coverage and Economic Security for Thousands of Oregon Families

Star Tribune – A next-generation model for MinnesotaCare

The Commonwealth Fund – Innovation Waivers: An Opportunity for States to Pursue Their Own Brand of Health Reform

Modern Healthcare – ACA offers a lower-cost option. Why are only two states using it?

Rutgers Center for State Health Policy – The Basic Health Plan Option in New Jersey

The Basic Health Program in New Mexico – SM54HM38 Report for New Mexico’s Legislative Finance Committee

New York State of Health – Fast Facts on Basic Health

Urban Institute – Oregon Basic Health Program Study

Urban Institute – The Basic Health Program Option Under Health Reform

State of Arkansas Department of Insurance – Consideration of the Basic Health Plan in Arkansas






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