On March 12, 2014, CMS released the final rule for the Basic Health Program. CMS established standards for state and federal administration of the program, including provisions regarding eligibility and enrollment, benefits, cost-sharing requirements and oversight activities. Where possible, CMS aligned Basic Health Program rules with existing rules governing coverage through the Marketplace, Medicaid, or CHIP to simplify administration for states and promote coordination between the Basic Health Program and other health insurance programs.
The final notice provides the methodology and data sources necessary to determine federal payment amounts made in program year 2016 to states that elect to use the Basic Health Program to offer health benefits to low-income individuals who are otherwise eligible to purchase coverage through the Marketplace. The final notice uses the same methodology as the final 2015 payment notice.