Basic Health Program (Affordable Care Act)
Program Funding
Annual program obligations reported to SAM.gov.
Program Objective
Section 1331 of the Affordable Care Act gives states the option of creating a Basic Health Program (BHP), a health benefits coverage program for low-income residents who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace. The program is for specified individuals who do not qualify for Medicaid but whose income does not exceed 200 percent of the federal poverty level (FPL).
Eligibility
Eligible Applicants
- State
Any State that submits a BHP Blueprint may be considered for certification by the Secretary of HHS.
How to Apply
Award Procedure
The Secretary will certify a BHP Blueprint provided it meets all of the following standards: (1) The Blueprint contains sufficient information for the Secretary to determine that the BHP will comply with the requirements of section 1331 of the Affordable Care Act and Part 600 of 42 CFR; (2) The BHP Blueprint demonstrates adequate planning for the integration of BHP with other insurance affordability programs in a manner that will permit a seamless, coordinated experience for a potentially eligible individual; (3) The Blueprint is a complete and comprehensive description of the BHP and its operations, demonstrating thorough planning and a concrete program design, without reserved decisions on operational features.
The Blueprint should be submitted with enrollment data and premium information at least 6 weeks prior to effective date requested.
Program details & compliance
Description
Section 1331 of the Affordable Care Act gives states the option of creating a Basic Health Program (BHP), a health benefits coverage program for low-income residents who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace. The program is for specified individuals who do not qualify for Medicaid but whose income does not exceed 200 percent of the federal poverty level (FPL).
Mission Categories
Primary: General Health and Medical
Use of Funds
Allowed Uses
The federal BHP payment is made to a state trust fund for BHP. Funds in the state trust fund may not be used for any purposes other than paying BHP benefits and reducing premiums and cost-sharing for eligible individuals enrolled in BHP standard health plans. BHP Trust funds may not be expended for any purpose other than those specified above. In addition, BHP trust funds may not be used for purposes including bu t not limited to: (1) determining the amount of non-federal funds for the purposes of meeting matching or expenditure for federal funding; (2) program administration of BHP or any other program; (3) payment to providers not associated with BHP services or requirements; or (4) coverage for individuals not eligible for BHP.
Required Documentation
The BHP Blueprint is a comprehensive written document submitted by the state to the Secretary for certification of a BHP in the form and manner specified by HHS. The Blueprint will establish compliance with applicable requirements by including a description, or if applicable, an assurance of: (1) minimum benefits offered including essential health benefits; (2) the competitive process that the state will undertake to contract for the provision of standard health plans; (3) the standard contract requirements that the State will incorporate into its standard health plan contracts; (4) the methods by which the State will enhance the availability of standard health plan coverage; (5) the methods by which the state will ensure and promote coordination with other insurance affordability programs; (6) the premium standards; (7) the cost sharing imposed under the BHP; (8) the disenrollment procedures and consequences of nonpayment of premiums; (9) the standards used to determine eligibility for the program; (10) the state’s policies regarding enrollment, disenrollment and verification, along with a plan to ensure coordination with and eliminate gaps in coverage for individuals transitioning to other insurance affordability programs; (11) the fiscal policies and accountability procedures; (12) the process by which BHP trust fund trustees shall be appointed, the qualifications and responsibilities of such trustees, and any arrangements to insure or indemnify such trustees against claims or breaches of their fiduciary responsibilities; (13) a description of how the state will ensure program integrity; (14) an operational assessment establishing operating agency readiness; (15) a transition plan if a state participating in 2015 plans to propose an alternative enrollment strategy for initial implementation. This program is excluded from coverage under OMB Circular No. A-87.
Reporting & Compliance
Applicable 2 CFR 200 Subparts
- Subpart F — Audit Requirements