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CMS Releases Basic Health Plan Final Rule

The Centers for Medicare & Medicaid Services released March 7 a final rule on the Affordable Care Act’s (ACA’s) basic health plan (BHP), which is an optional coverage program for people who are not eligible for Medicaid, earn no more than 200 percent of the federal poverty level (FPL), and would otherwise be eligible to purchase coverage through the health insurance marketplaces (exchanges).

In the rule, CMS finalized its proposal to allow states to use marketplace or Medicaid managed care requirements to certify BHP program networks. In commenting on the proposal, America’s Essential Hospitals raised concerns that these requirements would not guarantee essential providers’ inclusion in BHP networks.

CMS also finalized its proposal to allow states to use either the annual open enrollment model (which specifies a period of time during which people can enroll in BHPs) or a continuous enrollment model (which allows people to sign up for BHP coverage at any time during the year). The association encouraged CMS to require continuous enrollment so individuals who become eligible for coverage after an open enrollment period can still obtain health insurance coverage without having to wait until the following year’s open enrollment period.

With respect to BHP reimbursement rates, CMS declined to establish specific standards in the final rule and left states with flexibility.

CMS also released March 7 its final methodology for determining federal payments to states establishing a BHP program in 2015. These states will receive federal funding equal to 95 percent of the amount of the premium tax credit and cost-sharing assistance that would have been provided to BHP consumers if they had enrolled in a marketplace plan instead.

Please contact Xiaoyi Huang, policy director, at or 202.585.0127 with questions.


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