The Affordable Care Act (ACA) has provided coverage to millions of Americans through expanded Medicaid eligibility and financial assistance to purchase private health insurance through Health Insurance Marketplaces. For the first time, all individuals up to 138% of the federal poverty level are eligible for Medicaid coverage if they live in a state that expanded the program. For individuals with incomes above the Medicaid threshold, premium assistance and cost-sharing reductions are available to help defray the costs of coverage.
Recognizing that states may want to offer lower cost-sharing options to these individuals, legislators drafted Section 1331(a) of the Affordable Care Act to give states the option to establish a BHP, which covers the essential health benefits of low-income individuals who would otherwise receive federal subsidies to purchase Marketplace coverage.
The federal government pays the state 95 percent of what it would have paid in financial assistance for BHP enrollees were they to enroll in the Marketplace. To qualify for BHP coverage, individuals must either have a household income between 133 and 200 percent FPL or be a lawfully present non-citizen earning under 133% FPL who cannot qualify for Minimum Essential Coverage (MEC), Medicaid, or CHIP due to immigration status.
The purpose of this brief is to explore the progress, differences, and similarities of the implementation of BHPs in Minnesota and New York, particularly given policymakers desire to increase state flexibility under a new Administration.