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Basic Health Program Eligibility Determinations

We will determine whether States made Basic Health Program (BHP) payments on behalf of beneficiaries who did not meet Federal and State eligibility requirements. Section 1331 of the Affordable Care Act (ACA) gives States the option to create a BHP that provides health benefits coverage for low-income residents, citizens or lawfully present non-citizens, who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace. The option also gives States the ability to provide more affordable coverage for these low-income residents and improve continuity of care for people whose income fluctuates above and below Medicaid and Children's Health Insurance Program levels. The BHP is funded primarily by Federal funds and must include 10 essential health benefits specified by the ACA.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
July 2020 Centers for Medicare and Medicaid Services Basic Health Program Eligibility Determinations Office of Audit Services W-00-20-31549 2021