Healthcare Business News

CMS issues ACA Basic Health Program final rules

By Paul Demko
Posted: March 7, 2014 - 6:45 pm ET

Starting in 2015, states will have the option of establishing subsidized health insurance plans for individuals and families with incomes between 138% and 200% of the federal poverty level. On Friday, the CMS issued final rules (PDF) for establishing what's known as a Basic Health Program under the Patient Protection and Affordable Care Act.

That model for covering the working-poor population is favored by officials in a number of states, including Washington and Minnesota, that argue that it's a more cost-effective and affordable approach.

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Basic Health Programs also are intended to enhance continuity in coverage and care for people who tend to go back and forth between Medicaid and private plans, a dynamic referred to as churn. The Basic Health Program provision was added to the federal healthcare law at the behest of Sen. Maria Cantwell (D-Wash.) and was modeled on Washington's program.

Under the rules announced by the CMS, states choosing to establish a Basic Health Program will receive 95% of the cost that the federal government would have incurred if enrollees instead opted to use federal premium subsidies and buy coverage in the federal or state insurance exchanges. Basic Health Program plans are required to provide coverage for all 10 essential coverage benefits, as defined by the ACA. States can add other benefit requirements if they so choose.

Under the new rule, premiums and other costs can't be higher than what individuals would have paid if they had purchased private coverage through the exchanges. States have the option of using the open enrollment period for the exchanges or allowing continuous enrollment.

Originally under the ACA, states were supposed to be able to launch Basic Health Programs this year. But like other provisions of the ACA, implementation was pushed back a year.

Follow Paul Demko on Twitter: @MHpdemko

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