CMS released a proposed rule outlining the requirements for the Affordable Care Act’s Basic Health Program (BHP), which is scheduled to be implemented in 2015. The program is designed for states to offer lower-cost health coverage options to residents with annual incomes that exceed the eligibility threshold for Medicaid, but are unable to afford the health plans in the law’s insurance exchanges.
The Obama administration delayed the BHP program until January 1, 2015 because the Health and Human Services (HHS) Department did not have enough time to issue the necessary guidelines by January 2014.
The proposed rule offers a framework for states to ensure that their standard health plans under the BHP meet eligibility, enrollment and benefit requirements as required by ACA. The proposed rule states that plans must comply with the ACA’s essential health benefits requirements, such as the availability of preventive and emergency care services. In addition, the plans would be prohibited from denying coverage to individuals based on their age or if they have any pre-existing conditions. It also establishes the same cost-sharing standards used in the online marketplaces and bans cost-sharing for preventive services.
