The Affordable Care Act (ACA), officially known as the Patient Protection and Affordable Care Act, brought about significant changes to the healthcare landscape in the United States. One key component of this landmark legislation is the option for states to establish a Basic Health Program (BHP) under Section 1331. This initiative is a crucial piece of affordable care act public health programming, designed to provide accessible and cost-effective health coverage for low-income residents.
Understanding the Basic Health Program
The Basic Health Program is specifically tailored to assist individuals and families who earn too much to qualify for Medicaid but still struggle to afford private health insurance. These are residents who would typically be eligible to purchase coverage through the Health Insurance Marketplace, but the BHP offers a more affordable alternative. By creating a BHP, states can ensure better healthcare access and improve the continuity of care, especially for those whose income levels may fluctuate, sometimes placing them above and sometimes below the Medicaid and Children’s Health Insurance Program (CHIP) eligibility thresholds.
Who is Eligible for BHP?
Eligibility for the Basic Health Program is defined by specific criteria. It is open to:
- Citizens and lawfully present non-citizens.
- Individuals not eligible for Medicaid, CHIP, or other forms of minimum essential coverage.
- Residents with incomes between 133 percent and 200 percent of the federal poverty level (FPL).
- Lawfully present non-citizens with incomes below 133 percent of the FPL who are restricted from Medicaid due to their immigration status are also eligible.
This targeted approach ensures that the affordable care act public health programming through BHP effectively reaches those in genuine need of affordable healthcare options.
Essential Health Benefits and Cost Sharing
The benefits provided under a Basic Health Program are comprehensive, mirroring the essential health benefits mandated by the Affordable Care Act. These include vital services such as:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Furthermore, to maintain affordability, the monthly premiums and cost-sharing for individuals enrolled in a BHP are capped. These costs will not exceed what an eligible individual would have paid if they had enrolled in a qualified health plan (QHP) through the Marketplace. This cost limitation is a cornerstone of the affordable care act public health programming’s commitment to making healthcare financially accessible.
Federal Funding for State BHPs
To support states in operating Basic Health Programs, the federal government provides significant funding. States with approved BHPs receive federal funds equivalent to 95 percent of the premium tax credits and cost-sharing reductions that would have otherwise been provided to eligible individuals if they had enrolled in QHPs via the Marketplace. This funding mechanism ensures the financial viability and sustainability of state-run Basic Health Programs, reinforcing the affordable care act public health programming at the state level.
State Implementation Examples
Several states have taken the initiative to implement Basic Health Programs, demonstrating the practical application of this aspect of the affordable care act public health programming:
- Minnesota: A pioneer in BHP implementation, Minnesota launched its program on January 1, 2015. Their experience serves as a model for other states.
- Oregon: The state of Oregon recently gained approval for its Basic Health Program on June 7, 2024, with implementation scheduled for July 1, 2024. This expansion shows the continued relevance and adoption of BHP.
- New York: New York previously operated a BHP starting April 1, 2015, but temporarily suspended it on April 1, 2024. This highlights the dynamic nature of program implementation and potential adjustments over time.
Resources for States: The BHP Blueprint and Federal Guidance
For states considering or currently operating a Basic Health Program, valuable resources are available:
- Basic Health Program Blueprint: This blueprint is the official form states must use to formally request certification for their BHP. It guides states in outlining their program design, operations, management, and compliance with federal regulations.
- Federal Guidance and Methodologies: The federal government provides ongoing guidance through notices of proposed rulemaking and final rules to ensure coordination between BHP and other insurance affordability programs. They also offer detailed methodologies for calculating federal payment amounts to states. Additionally, resources like state reports for health insurance exchange premiums and reports on implementation experiences from states like New York and Minnesota offer crucial insights and data.
Conclusion
The Basic Health Program, authorized by the Affordable Care Act, represents a vital avenue for states to enhance public health programming and expand affordable healthcare access to low-income residents. By understanding the eligibility criteria, benefits, funding mechanisms, and leveraging available resources, states can effectively utilize the BHP to create a more equitable and accessible healthcare system. This initiative is a testament to the ongoing efforts to strengthen the nation’s public health infrastructure through strategic and impactful programming under the Affordable Care Act.
