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CMS delays BHP until 2015

Posted on February 11, 2013 | No Comments

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According to a set of frequently asked questions (FAQs) released by the Centers for Medicare & Medicaid Services (CMS), federal officials are delaying until 2015 the Basic Health Program (BHP), a health care overhaul option that would enable states to use federal tax subsidies to cover low-income people (those with incomes between 139 and 200 percent of the federal poverty level) whose income is too high to qualify for Medicaid. The BHP is an alternative to offering this population coverage through the exchanges that will begin operation in January 2014. Consumers receiving insurance through the BHP would not have to reimburse the federal government if their income fluctuates during the year.

CMS officials intend to release BHP proposed rules for comment in 2013 and final guidance in 2014, in order for the program to begin operation in 2015.

The FAQ covers a number of other topics as well. The document provides information regarding the increased federal matching rate for consumers newly eligible for Medicaid in 2014 and addresses coverage for pregnant women and children.

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The US Department of Health and Human Services (HHS) provided a timeline for the installation of the Basic Health Program (BHP) to Senator Maria Cantwell (D-WA), a champion of the model. Pursuant to Section 1331 of the Affordable Care Act (ACA), the BHP was intended to serve as a special state insurance option for low-income families and individuals, yet no deadline for HHS to create the BHP was stated in the statute. The timeline details key implementation events from now until January 1, 2015, the time at which the BHP is scheduled to become operational.
The Centers for Medicare and Medicaid Services (CMS) of the US Department of Health and Human Services (HHS) has issued a Request for Information (RFI) on the Basic Health Program (BHP). The BHP is designed to offer an alternative pathway to coverage for low-income families, and must provide at least the same level of mimimum essential health benefits offered to other consumers through plans sold in the State's Exchange. The RFI seeks input from stakeholders on what they feel will be challenges and costs associated with the BHP, how the BHP might affect the Exchange, and innovative strategies States could use in contracting with standard health plans. For more information on the BHP, click here.
On February 6, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a new series of ACA-related Frequently Asked Questions (FAQs). The first two questions address the Basic Health Program (BHP). As described in an earlier Implementation Brief, the BHP was included in the ACA as a special state coverage option for low-income families and individuals. In answer to the question “When will the Basic Health Program be operational?”, CMS replied that the agency does not intend to propose implementing rules until sometime in 2013 and furthermore, that final rules will not be issued until 2014. The status of the Basic Health Program emerged as one of the subjects of a Senate Finance Committee’s ACA oversight hearing on February 14, 2013, during which Senator Maria Cantwell (D-WA), who sponsored the legislative amendment creating the BHP, questioned CCIIO Director Gary Cohen on the timing of BHP guidance.
An important issue in implementing the Affordable Care Act (ACA) is how to address the needs of uninsured low-income individuals and families whose incomes exceed Medicaid eligibility levels but are less than twice the federal poverty level (about $37,000 for a family of 3 in 2011). Under the ACA, the basic approach to assisting such individuals and families is the state health insurance Exchange, which enables qualified individuals to secure coverage and provides access to premium assistance and cost-sharing subsidies aimed at making coverage and care affordable.
The Center on Budget and Policy Priorities (CBPP) recently released a report which first describes the Basic Health option, next reviews the issues states should consider in determining whether to adopt it, and finally assesses the issues on which states urgently need federal guidance in order to fully assess the option and whether it is appropriate for them. For more information on the Basic Health program, click here.
Families USA's paper, "The Basic Health Option: Will It Work for Low-Income Consumers in Your State?" reviews the concept of the Basic Health Program (BHP), discusses some potential program pitfalls, and raises key issues that can influence the direction that a BHP might take in states with varying financial and political constraints. Some key challenges highlighted in the paper of the BHP include the provision of seamless coverage and provider payment rates.
A new policy brief issued by the Community Service Society (CSS) of New York examines that state's options related to establishing a Basic Health Program (BHP) under the Affordable Care Act (ACA). The brief, "Bridging the Gap: Exploring the Basic Health Insurance Option for New York," determines that if adopted, a BHP in New York State could provide no-cost coverage to 467,000 low-income residents.