Basic Health Program (Affordable Care Act)

Section 1331 of the Affordable Care Act gives states the option of creating a Basic Health Program (BHP), a health benefits coverage program for low-income residents who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace.

The program is for specified individuals
who do not qualify for Medicaid but whose income does not exceed 200 percent of the federal poverty level (FPL).

Agency - Department of Health and Human Services

The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.

Office - See Regional Agency Offices.

See Regional Agency Offices.

Contact the Associate Regional Administrator, Division of Medicaid, Center for Medicaid, CHIP and Survey & Certification.

(See Appendix IV of the Catalog for addresses and telephone numbers.).



Program Accomplishments

Not Applicable.

Uses and Use Restrictions

The federal BHP payment is made to a state trust fund for BHP.

Funds in the state trust fund may not be used for any purposes other than paying BHP benefits and reducing premiums and cost-sharing for eligible individuals enrolled in BHP standard health plans.

BHP Trust funds may not be expended for any purpose other than those specified above.

In addition, BHP trust funds may not be used for purposes including bu t not limited to: (1) determining the amount of non-federal funds for the purposes of meeting matching or expenditure for federal funding; (2) program administration of BHP or any other program; (3) payment to providers not associated with BHP services or requirements; or (4) coverage for individuals not eligible for BHP.

BHP Trust funds may not be expended for any purpose other than those specified in section 070 above.

In addition, BHP trust funds may not be sued for other purposes including but not limited to: (1) Determining the amount of non-Federal funds for the purposes of meeting matching or expenditure requirements for Federal funding; (2) Program administration of BHP or any other program; (3) Payment to providers not associated with BHP services or requirements; or (4) Coverage for individuals not eligible for BHP.

Eligibility Requirements

Applicant Eligibility

Any State that submits a BHP Blueprint may be considered for certification by the Secretary of HHS.

Beneficiary Eligibility

The program is for specified individuals who do not qualify for Medicaid but whose income does not exceed 200 percent of the federal poverty level (FPL).

Credentials/Documentation

The BHP Blueprint is a comprehensive written document submitted by the state to the Secretary for certification of a BHP in the form and manner specified by HHS. The Blueprint will establish compliance with applicable requirements by including a description, or if applicable, an assurance of: (1) minimum benefits offered including essential health benefits; (2) the competitive process that the state will undertake to contract for the provision of standard health plans; (3) the standard contract requirements that the State will incorporate into its standard health plan contracts; (4) the methods by which the State will enhance the availability of standard health plan coverage; (5) the methods by which the state will ensure and promote coordination with other insurance affordability programs; (6) the premium standards; (7) the cost sharing imposed under the BHP; (8) the disenrollment procedures and consequences of nonpayment of premiums; (9) the standards used to determine eligibility for the program; (10) the state?s policies regarding enrollment, disenrollment and verification, along with a plan to ensure coordination with and eliminate gaps in coverage for individuals transitioning to other insurance affordability programs; (11) the fiscal policies and accountability procedures; (12) the process by which BHP trust fund trustees shall be appointed, the qualifications and responsibilities of such trustees, and any arrangements to insure or indemnify such trustees against claims or breaches of their fiduciary responsibilities; (13) a description of how the state will ensure program integrity; (14) an operational assessment establishing operating agency readiness; (15) a transition plan if a state participating in 2015 plans to propose an alternative enrollment strategy for initial implementation. This program is excluded from coverage under OMB Circular No. A-87. This program is excluded from coverage under 2 CFR 200, Subpart E - Cost Principles.

Aplication and Award Process

Preapplication Coordination

Preapplication coordination is not applicable.

Environmental impact information is not required for this program.

This program is excluded from coverage under E.O.

12372.

Application Procedures

This program is excluded from coverage under 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.

Award Procedures

The Secretary will certify a BHP Blueprint provided it meets all of the following standards: (1) The Blueprint contains sufficient information for the Secretary to determine that the BHP will comply with the requirements of section 1331 of the Affordable Care Act and Part 600 of 42 CFR; (2) The BHP Blueprint demonstrates adequate planning for the integration of BHP with other insurance affordability programs in a manner that will permit a seamless, coordinated experience for a potentially eligible individual; (3) The Blueprint is a complete and comprehensive description of the BHP and its operations, demonstrating thorough planning and a concrete program design, without reserved decisions on operational features.

Deadlines

Not Applicable.

Authorization

Section 1331 of the Patient Protection and Affordable Care Act, (Pub. L. 111-148), and the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111.152, enacted March 30, 2010) which are collectively referred to as the Affordable Care Act.

Range of Approval/Disapproval Time

The Blueprint should be submitted with enrollment data and premium information at least 6 weeks prior to effective date requested.

Appeals

Not Applicable.

Renewals

In the event that a State seeks to make significant changes that alter program operations, the BHP benefit package, enrollment, disenrollment and verification policies described in the certified BHP Blueprint, the state must submit a revised Blueprint to the Secretary for review and certification. The State is responsible for continuing to operate under the terms of the existing certified Blueprint until and unless a revised Blueprint is certified.

Assistance Considerations

Formula and Matching Requirements

Statutory Formula: 42 CFR Part 600 [CMS-2380-FM] RIN 0938-ZB12 -- Annual Federal Funding Methodology published in Federal Register. This program has no matching requirements. This program does not have MOE requirements.

Length and Time Phasing of Assistance

N/A. Method of awarding/releasing assistance: quarterly.

Post Assistance Requirements

Reports

The state must submit an annual report that includes any evidence of fraud, waste, or abuse on the part of participating providers, plans, or the state BHP agency known to the state, and a detailed data-driven review of compliance with the following: (1) eligibility verification requirements; 2) limitations on the use of Federal funds; (3) requirements to collect quality and performance measures from all participating standard health plans focusing on quality of care and improved health outcomes; (4) requirements specified by the Secretary at least 120 days prior to the date of the annual report as requiring further study to assess continued state compliance with federal law, regulations and the terms of the state?s certified Blueprint.

No cash reports are required.

No progress reports are required.

No expenditure reports are required.

To determine whether the state is complying with the Federal requirements and the provisions of its BHP Blueprint, HHS may review, as needed, but no less frequently than annually, the compliance of the state with applicable laws, regulations and interpretive guidance.

No cash reports are required.

No progress reports are required.

No expenditure reports are required.

To determine whether the State is complying with the Federal requiremetns and the provisions of its BHP Blueprint, HHS may review, as needed, but no less frequently than annually, the compliance of the State with applicable laws, regulations and interpretive guidance.

Audits

In accordance with the provisions of 2 CFR 200, Subpart F - Audit Requirements, non-Federal entities that expend financial assistance of $750,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Non-Federal entities that expend less than $750,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in 2 CFR 200.503.

Records

a) Maintain an accounting system and supporting fiscal records to assure that the BHP trust funds are maintained and expended in accord with the applicable federal requirements such as OMB Circulars A-87 and A-133. (b) Obtain an annual certification from the BHP trustees, the state?s chief financial officer, or designee, certifying all of the following: (1) the state?s BHP trust fund financial statement for the fiscal year; (2) The BHP trust funds are not being used as non-federal share for purposes of meeting any matching of expenditure requirement of any federally-funded program; (3) the use of BHP trust funds is in accordance with federal requirements consistent with those specified for the administration and provision of the program. (c) Conduct an independent audit of BHP trust fund expenditures over a 3 year period to determine that expenditures made in 3 year period were allowable; (d) Publish annual reports on the use of funds, including a separate line item that tracks the use of funds to further reduce premiums and cost sharing or for the provision of additional benefits within 10 days of approval by the trustees and findings of audit conducted under (c) above if applicable.

Financial Information

Account Identification

20-0949-0-1-551.

Obigations

(Formula Grants) FY 16 $2,823,560,855; FY 17 est $4,370,000,000; and FY 18 est $4,490,000,000

Range and Average of Financial Assistance

N/A ? based on formula of state-specific data.

Regulations, Guidelines, and Literature

Not Applicable.

Information Contacts

Regional or Local Office

See Regional Agency Offices. See Regional Agency Offices. Contact the Associate Regional Administrator, Division of Medicaid, Center for Medicaid, CHIP and Survey & Certification. (See Appendix IV of the Catalog for addresses and telephone numbers.).

Headquarters Office

Kelly Whitener 7500 Security Blvd., Baltimore, Maryland 21244 Email: Kelly.Whitener@cms.hhs.gov Phone: 410-786-0719

Criteria for Selecting Proposals

Not Applicable.



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