A new proposed rule authorized under the Affordable Care Act would give states the option of offering a Basic Health Program for individuals who do not qualify for Medicaid and have income not exceeding 200 percent of the federal poverty level.

The Centers for Medicare and Medicaid Services will publish the proposed rule on September 25; it is now available here. The new program could be another option for individuals who can’t get Medicaid as many states have not expanded their programs, but the individuals are otherwise eligible to purchase subsidized coverage through a health insurance exchange.

The rule details CMS’ proposals for handling eligibility and enrollment, setting benefit standards, delivering care services, transferring funds to participating states, and providing federal oversight. “This issuance addresses everything that we believe to be essential to the establishment and operation of the BHP, with the specific exception of details on payment which will be issued separately,” CMS notes in the rule.

The agency proposes, “when possible,” to align Basic Health Plan rules with existing rules governing health insurance exchanges, Medicaid and Children’s Health Insurance Plan. “Recognizing that states may choose different ways to structure their BHP, when possible, we offer states flexibility in choosing to administer the program in accordance with Exchange rules or those governing Medicaid or CHIP. In those sections in which we propose to offer states the choice, states must adopt all of the standards in the referenced Medicaid or Exchange regulations.

CMS will accept comments on the proposed rule through November 25.

Register or login for access to this item and much more

All Health Data Management content is archived after seven days.

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access