CMS Proposes to Establish Basic Health Program for Low-Income Individuals

by Shannon Allen

The Centers for Medicare Medicaid Services (“CMS”) proposes a rule that establishes the Basic Health Program required by Section 1331 of the Affordable Care Act.  States, under the Basic Health Program, are provided with “flexibility” to set up a “health benefits coverage program” to help “low-income individuals” who are not eligible for Medicaid and who are eligible to buy insurance through the state’s “Affordable Insurance Exchange” (“Exchange”) (also known as a “Health Insurance Marketplace”).  Under this proposed rule, states will have another option to create a Basic Health Program for certain low-income individuals starting January 1, 2015.  The Basic Health Program aims to “coordinate with enrollment” in a Qualified Health Plan (“QHP”) through the Exchange, and assist with enrollment in the Children’s Health Insurance Program (“CHIP”) and Medicaid.

The CMS invites comment on the establishment and operation of the Basic Health Program and seeks input on areas of further development and coordination within existing regulations.  The CMS proposes to:

• Create certification requirements for state submitted Basic Health Program Blueprints and state administration of the Basic Health Program consistent with that Blueprint;
• Institute eligibility and enrollment requirements for standard health plan coverage offered through the Basic Health Program;
• Establish requirements for the benefits covered by such standard health plans;
• Provide for federal funding of certified state Basic Health Programs;
• Regulate the purposes for which states can use such federal funding;
• Set forth parameters for enrollee financial participation; and
• Establish requirements for state and federal administration and oversight of Basic Health Program funds.

Interested parties should submit comments by November 25, 2013 and should refer to file code CMS-2380-P.  Comments may be submitted in one of the following four ways (Note: comments cannot be accepted via facsimile (“fax”):

• Electronically: http://www.regulations.gov.
• Regular mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-2380-P, P.O. Box 8016, Baltimore, MD 21244-8016.
• Express or overnight mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-2380-P, Mail Stop C4-26-0, 7500 Security Boulevard, Baltimore, MD 21244-1850.
• Hand or courier: Washington, DC—Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue SW., Washington, DC 20201. Baltimore, MD—Centers for Medicare & Medicaid Services, Department of Health and Human Services, 500 Security Boulevard, Baltimore, MD 21244-1850. If you plan to deliver your comments to the Baltimore address, please call (410) 786-7195 begin_of_the_skype_highlighting in advance to schedule your arrival with one of our staff members.