The unwinding related section 1902(e)(14) strategies newly available to Medicaid and CHIP agencies can provide significant relief to states facing pending eligibility and enrollment actions and processing delays, workforce and systems limitations, and other operational challenges. Ensuring eligible individuals do not lose coverage for procedural or administrative reasons and supporting those who are ineligible for Medicaid/CHIP transition to Marketplace coverage will be paramount for all states as they begin to resume normal operations when the federal public health emergency (PHE) ends. This expert perspective outlines the time-limited targeted enrollment flexibilities that CMS has availed to states through section 1902(e)(14) waiver authority and discusses considerations beyond the strategies described in federal guidance and supplemental resources.
Revisiting the Basic Health Program
Patricia Boozang, Kyla Ellis, and Amy Zhan, Manatt Health
State policymakers are focused on increasing access to and affordability of health care coverage—especially in light of the COVID-19 pandemic and the priorities of the new Biden-Harris administration. Recently, state interest has turned to introducing new state-sponsored coverage and adopting the Affordable Care Act (ACA) Basic Health Program (BHP) option.
The BHP is an option, established under Section 1331 of the ACA, that allows states to establish a coverage program for individuals with household income under 200 percent of the federal poverty level (FPL) with federal financial support. To date, BHPs have been established in New York and Minnesota. Both states have seen significant BHP enrollment, due in large part to low consumer premiums and cost-sharing compared with the Marketplace, leading other states to look to the program as a possible strategy to meet their affordability goals.
States—both those with existing BHPs and those interested in implementing a BHP—are also interested in expanding eligibility beyond the current 138 percent to 200 percent FPL population. This could be accomplished through statutory reforms to Section 1331 of the ACA, through a Section 1332 waiver, and/or by establishing a buy-in program to allow residents to purchase low-cost BHP coverage.
This issue brief provides a refresher on the BHP structure as outlined in the ACA, lessons learned from the two states that have implemented the program to date, and considerations for further evolution of the program under legislative or executive action.