Basic Health Program
States may choose to establish a basic health program to provide coverage to low-income individuals. This option allows states to design benefits specifically for this population, different from those offered in either Medicaid or the Exchange.
*Milestone details:
*Full name: Decide whether or not to offer a state basic health program to offer coverage to people not eligible for Medicaid with household income of 133% - 200% FPL.
*Relevance to the ACA:
The ACA allows states to contract with health plans to provide coverage to individuals with household incomes that exceed 133% but not 200% of the FPL. If a state chooses this option, individuals eligible for the basic health program may not obtain coverage through the Exchange. A state basic health program must include at least the essential health benefits. For states that elect this option, the federal government will provide funds equal to 85% of the premium tax credits that enrolled individuals would have received had they had enrolled in plans through an Exchange. (§1331)
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District of Columbia
In a recently released Medicaid FAQ document, CMS announced that the Basic Health Program will be operational beginning in 2015 for states interested in pursuing this option. HHS is working with states that are interested in the concepts included in the Basic Health Program option to identify similar flexibilities to design coverage systems for 2014.
District of Columbia
On January 31, 2013, the Minnesota State House and Senate introduced HF214 and SF184, to designate MinnesotaCare as the State’s Basic Health Program under the ACA. MinnesotaCare currently provides coverage for individuals with income levels higher than those eligible for Medicaid.
District of Columbia
A webinar listener asked how the BHP might impact an exchange's risk and pricing. See the question and answer here: http://www.statereforum.org/discussions/exchange-policy-decisions#commen...
District of Columbia
This presentation from the Association for Utah Community Health highlights the potential impacts of a Basic Health Plan (BHP) in the state. The presentation notes that estimated administrative costs to the state would be under 4 percent, and that the BHP would improve affordability for enrollees.
District of Columbia
In the June 2012 issue of Health Affairs the authors analyze census data and find that adopting a Basic Health Program would reduce churning by 4 percent, or approximate 1.8 million adults annually. They also find that overall churn rates would remain high, and other policies would be needed to minimize coverage disruptions.
Read the full text below and chime in. Is your state considering a Basic Health Program? What other policies are needed to minimize coverage disruptions for individuals moving back and forth between Medicaid and the exchange?
District of Columbia
Veronica Guerra of CHCS recently wrote a guest blog for State Refor(u)m with some potential policies for states to ensure continuity of care between Medicaid and the exchanges. Check it out here: http://www.statereforum.org/blog/coverage-and-churn-ensuring-continuity-...
District of Columbia
Using the Washington State Population Survey, augmented with results from the Urban Institute’s Health Insurance Policy Simulation Model, this report provides estimates on eligibility, enrollment, and costs for a Basic Health Program for Washington State under the rules defined in the Affordable Care Act. Results show that more than 160,000 Washington residents would be eligible for a Basic Health Program and enrollment was estimated to be between 75,000 and 111,000. The authors find that, even if Washington elected to support a Basic Health Program, the state’s health insurance exchange would still cover about 250,000 lives, and the program would not notably affect premiums in the individual insurance market.
District of Columbia
Politico Pro reports that Massachusetts has decided to implement the Basic Health Plan option for individuals between 133 and 200 percent FPL. While other states are exploring the option, Massachusetts is the first state to decide to move forward with implementing it. If you are a Politico Pro subscriber, you can read more here: https://www.politicopro.com/go/?id=11630
The California Healthcare Foundation has conducted an analysis of the potential impact of the basic health plan option in California. The analysis provides an overview of the BHP's potential impact on coverage, continuity, the exchange, and the state's finances.
Vermont
VT's first cut on the BHP option
District of Columbia
In January 2012, Maryland released an analysis of the issues related to implementing the ACA's basic health option in the state. Key issues discussed in the report include affordability, churning, administrative capacity, and the potential effects of the BHP on operation of the state's exchange. Also attached is a presentation of the report by Chuck Milligan, Deputy Secretary of Health Care Financing.
District of Columbia
As states develop legislation this year to establish exchanges and plan for implementation of the ACA's coverage expansions and health insurance market reforms, they should consider whether or not to establish a Basic Health program. This Center on Budget and Policy Priorities paper describes the Basic Health option, the issues states should consider in determining whether to adopt it, and the issues on which states urgently need federal guidance in order to fully assess the option and whether it is appropriate for them.
District of Columbia
This issue brief presents a background assessment of Washington State’s current programs and eligibility and projections for the population eligible for the Federal Basic Health Program from 134 - 200 percent FPL. A financing and cost estimate for the Federal Basic Health Program is provided here as well as a discussion of the advantages and disadvantages of such a program in Washington State. Where appropriate, insights into the perspective of or the impact upon consumers, employers, insurers, and health care providers in the private and public health insurance markets are discussed. A framework for considering these issues and a recommendation for moving forward is also provided.
District of Columbia
In November 2011, Rhode Island conducted an initial assessment of the basic health plan option. The assessment provides an overview of the BHP option, key considerations for deciding whether to pursue the option, and suggested conditions for participation.
District of Columbia
A recent paper, published by the Urban Institute, estimates the national and state-specific effects of implementing a basic health program. The paper examines what effects a Medicaid-like plan option would have on premiums, enrollment, and the exchange.
District of Columbia
Deborah Bachrach and Melinda Dutton of Manatt Health Solutions have outlined a four-step approach that states can take when assessing whether or not to pursue the basic health plan option. This presentation outlines the four-step approach and suggests some considerations and implications for states, as they decide whether to pursue the basic health plan option.
District of Columbia
A microsimulation model published in Health Affairs raises issues about churning associated with the Basic Health Program option. How are states weighing the trade-offs? What design options in the Basic Health Program are states considering to minimize churning?
District of Columbia
Tennessee developed a proposal for a bridge option as an alternative to the Basic Health Program entitled "One Family, One Card" aimed at promoting continuity of coverage.
District of Columbia
Last week, a Federal Register included a CMS request for information, asking stakeholders for input on Basic Health Programs, in advance of a rule-making effort. CMS is asking for feedback on several dozen questions (ranging from high-level to very technical), including:
What are some of the major factors that States are likely to consider in determining whether to establish a Basic Health Program?
What are key considerations for States in placing responsibility for a Basic Health Program within the State organizational structure?
What are the challenges and costs associated with managing a Basic Health Program?
What additional standards, if any, should standard health plans participating in a State's Basic Health Program meet?
What consumer protections should be included? How should quality and performance be measured? What plan design issues should be considered?
What process should the Secretary use to certify or re-certify Basic Health Programs? How should this process be similar to or different from Exchange certification?
Comments on the RFI are due on October 31st.
District of Columbia
Here is a presentation that Stan Dorn, of the Urban Institute, gave on the basic health program. Urban also published a report earlier this year, which outlines issues that states and consumers should consider regarding the basic health program.
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