Fact File: The Basic Health Plan

What is the Basic Health Plan?

Regulation: The Basic Health Plan (BHP) program was included in the Affordable Care Act (ACA), Section 1331.

Eligibility: Consumers with incomes between 133% and 200% of federal poverty level, who would otherwise use tax credits to purchase coverage in the exchanges. Legal immigrants whose immigration status disqualifies them from Medicaid also are eligible.

Benefits: Plans must include the Essential Benefits. Enrollees cannot pay more in premiums or out-of-pocket than they would in the exchange.

Funding: The federal government would provide to the participating state 95% of what it would have otherwise spent on subsidies and cost-sharing reductions for the population. No matching funds from the state are required.

Goals: To reduce churning in and out of Medicaid and allow continuity of coverage; to offer additional cost protection for low-income consumers; to save money for states by moving the population into managed care rather than into Medicaid with a de facto federal block grant.