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.
A range of policy proposals to cut federal Medicaid funding under consideration by Congress could profoundly reshape the Medicaid program. Although the specific details of these proposals have not yet been defined, many entities are actively analyzing the possible effects on state Medicaid enrollment and spending. This expert perspective highlights the national 50-state analyses of Medicaid cuts that have been released. SHVS will continue to regularly monitor published estimates and update this expert perspective.
The budget reconciliation process is continuing to move forward in Congress and includes developing proposals in the House to identify $880 billion in federal savings over the next ten years, the vast majority of which will need to come from Medicaid. To support states in informing and validating their own fiscal and program impact estimates of federal policy changes, Manatt Health has developed, with support and input from State Health and Value Strategies, a new toolkit providing national and state-by-state data on the potential impact of key cuts under consideration in Congress. This expert perspective provides an executive summary of the toolkit.
Congress is considering a variety of federal policy changes that will have significant impacts on the Medicaid program, widely expected to reduce enrollment and federal Medicaid funding to states. A variety of state-level estimates have been released, which can be helpful for states as they consider how various policy proposals might impact their Medicaid programs. This expert perspective highlights state agencies that have estimated and quantified the potential impacts of various proposals on enrollment and spending. SHVS will continue to regularly monitor published estimates from states and update this expert perspective.
