Late News: Program establishes benefits for low-income individuals

The CMS late Friday laid out the standards for the healthcare reform law's Basic Health Program, which gives states the option to establish a health benefits program for low-income individuals who otherwise would be eligible to buy coverage in the health insurance exchanges. Effective after Jan. 1, 2015, the program would affect individuals whose incomes are between 133% and 200% of the federal poverty level.

Under a proposed rule, the CMS would give states the choice of using an annual open enrollment model—which the health insurance exchanges will use—or the continuous enrollment model that is used in Medicaid and most Children's Health Insurance Plans. In addition, it defines the types of entities that can contract with the state to provide a standard health plan for Basic Health Program enrollees, proposes a minimum standard of benefits, known as “essential health benefits,” and makes provisions for other benefits. And, consistent with the Patient Protection and Affordable Care Act, the rule provides that monthly premiums can't exceed the monthly premium an individual would have paid in the second-lowest cost “silver” plan in an exchange. And it establishes the same cost-sharing standards used in the insurance exchanges and prohibits cost-sharing for preventive services.