CMS Issues Notice Establishing Basic Health Program Funding MethodologyImage Banner

CMS Issues Notice Establishing Basic Health Program Funding Methodology

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CMS Issues Notice Establishing Basic Health Program Funding Methodology

February 20, 2015
On Thursday, the Centers for Medicare and Medicaid Services (CMS) issued a final notice establishing the methodology for determining federal funding for the Basic Health Program in program year 2016. The Basic Health Program provides states with the option to establish a health benefits coverage program for lower-income individuals as an alternative to Health Insurance Marketplace coverage under the Affordable Care Act. This voluntary program enables states to create a health benefits program for residents with incomes that are too high to qualify for Medicaid through Medicaid expansion in the Affordable Care Act, but are in the lower income bracket to be eligible to purchase coverage through the Marketplace. This final notice is substantially the same as the final notice for program year 2015.

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.

 
To read CMS' press release announcing the notice, click here.