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.
Medicaid enrollment has increased by over 10 million (or 15 percent) from February 2020 through February 2021 across all states since the outbreak of the COVID-19 pandemic. States have a clear imperative to center health equity as they plan for the end of the public health emergency (PHE) given that Black, Latino/a, and other people of color are most at risk of coverage loss. This expert perspective highlights strategies states can implement to ensure that the end of the PHE does not exacerbate already widespread racial and ethnic disparities in our health care system.
COVID-19 vaccines are now widely accessible in the United States and free to everyone over the age of 12. Given the spread of the Delta variant, there is an urgent need to increase vaccination rates, particularly among Medicaid enrollees. States across the country continue to report Medicaid enrollees are getting vaccinated at lower rates than the general population. This expert perspective explores how state Medicaid managed care programs and health plans can work collaboratively to increase COVID-19 vaccination rates for the more than 55 million Medicaid enrollees in comprehensive managed care plans.
Many states are looking to fill gaps in race and ethnicity data for Medicaid and related agencies. Working with the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota, with support from the State Health and Value Strategies (SHVS) program, New York tested multiple strategies aimed at encouraging applicants to answer the optional race and ethnicity questions. This expert perspective highlights an effort by New York’s official state-based marketplace, NY State of Health, to improve the completeness of race and ethnicity data that applicants share when applying for Medicaid; Child Health Plus, the state’s Children’s Health Insurance Program (CHIP); the Essential Plan, New York’s Basic Health Program (BHP); or Qualified Health Plan (QHP) coverage through its Marketplace.