Basic Health Program


Filling the Low-Income Coverage Gap


After nearly half of states declined to expand Medicaid, the government soon realized that a large population of Americans would be stuck without coverage. Low-income individuals who don’t qualify for Medicaid in their state and don’t earn enough to qualify for a subsidy on the marketplace were an unexpected obstacle for the health law once the Supreme Court decided Medicaid expansion was optional.


In September 2013, the Department of Health and Human Services released a proposed rule to start the Basic Health Program. The program would be an umbrella for needy individuals who, despite their lack of income, would be penalized by the law for being uninsured even though they wouldn’t be able to afford anything.


The ACA was written with the idea that each state would increase access to Medicaid, and after expansion became an option, it was clear that something needed to be resolved for the left behind group. The BHP was established by Congress to let states choose to offer a program for their low-income uninsured population.


Modeled after a Washington State program, the goal of the BHP was to lower coverage costs for this group, which often is paid for with tax dollars. Additionally, this group is expected to cycle in and out of Medicaid eligibility due to slight fluctuations in earnings.


By November 2013, the HHS released the Basic Health Program Summary NPRM Overview, setting forth a few more details about the plan.


Basic Health Program Rules and Eligibility


If states choose to create a BHP, they will provide insurance coverage to US citizens or legal residents who are not eligible for Medicaid, CHIP or other minimum essential coverage.


Income must be between 133 and 200 percent of poverty. Legal residents with income less than 133 percent of poverty who don’t qualify for Medicaid due to non-citizen status are also eligible.


Like other programs established by the Obamacare law, BHP plans must cover at least the ten main categories of essential health benefits. Premium rates and cost sharing expenses would not exceed what an exchange plan member would have been charged.




Centers for Medicare and Medicaid Servcies: BHP Proposed Rules