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CMS Outlines Basic Health Program Details

CMS Outlines Basic Health Program Details

September 23, 2013 — CMS on Friday released a proposed rule outlining various requirements for the Affordable Care Act's (PL 111-148) Basic Health Program, which is scheduled to be implemented in 2015, The Hill's "Healthwatch" reports (Viebeck, "Healthwatch," The Hill, 9/20).

The program was designed for states to offer lower-cost health coverage options to residents who have annual incomes that exceed the eligibility threshold for Medicaid but are unable to afford the health plans in the law's insurance exchanges (Adams, CQ HealthBeat, 9/20). The BHP plans would be available to individuals with annual incomes up to two times the federal poverty level, or about $47,000 for a family of four.

In February, the Obama administration announced that implementation of the BHP will be delayed until Jan. 1, 2015 -- one year later than scheduled in the ACA -- because HHS did not have enough time to issue the guidelines necessary to launch the program in January 2014 (Women's Health Policy Report, 2/8).

Details of Proposed Rule

According to CQ HealthBeat, the proposed rule offers a framework for states to ensure that their standard health plans under the BHP meet eligibility, enrollment and benefit requirements as required by the ACA. In addition, the proposed rule guides states on how they can use federal funding for the program and how consumers' payments should be handled (CQ HealthBeat, 9/20).

The proposed rule states that plans would have to comply with the ACA's essential health benefits requirements, such as the availability of preventive and emergency care services. In addition, the plans would be prohibited from denying coverage to individuals based on their age or if they have any pre-existing conditions ("Healthwatch," The Hill, 9/20).

States would have the option to operate their plans under an annual open-enrollment model -- similar to the model being used for the exchanges next month -- or a continuous open model used in Medicaid, Modern Healthcare reports.

Further, monthly premiums for the program's plans cannot exceed the premiums that an individual would pay for the second lowest-cost silver plan in the ACA's exchanges. It also establishes the same cost-sharing standards used in the online marketplaces and bans cost-sharing for preventive services (Zigmond, Modern Healthcare, 9/20).