What is the Basic Health Program (BHP)?

Calendar Icon Updated January 15, 2019
Medicaid

The Basic Health Program (BHP) was designed for low-income families. It complements and coordinates with enrollment in a qualified health plan through the Marketplace, Medicaid, and the Children’s Health Insurance Program (CHIP). This means you may not have to apply for this program independently, but rather, it will be offered as an option when you are applying for other healthcare programs.

Although not all states offer this, BHP is a free program for families with incomes between 133% and 200% of the FPL. These families would otherwise be able to buy health coverage through the Health Insurance Marketplace. It works to enhance the services families can access for free and reduce their overall healthcare expenses.

BHP was created under Section 1331 of the Affordable Care Act, and it recognizes that not all families that are eligible to buy insurance through the Marketplace are able to realistically afford it. Offering a BHP allows states to provide consistent care for families that are low-income, as well as families that have a fluctuating income. This often includes families that are self-employed or have jobs based on tips or commission.

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BHP makes health coverage available to non-citizens that do not qualify for Medicaid due to their immigration status. It also provides the minimum essential coverage required under the Affordable Care Act. This means those on a BHP will not be subject to an uninsured penalty. The benefits of this program, if offered by the state, must cover at least the ten essential health benefits outlined in the Affordable Care Act.

Those 10 essential health benefits are:

  • Prenatal and postpartum care
  • Emergency Room visits
  • Prescription drugs
  • Outpatient care
  • Inpatient hospital care
  • Mental health and substance abuse treatment and counseling
  • Lab tests
  • Recovery services including occupational therapy, physical therapy, psychiatric care, and speech-language pathology.
  • Preventative services
  • Pediatric care including dental and vision

For states that offer BHP, the federal government will provide funding equaling 95% of the premium tax credits and cost-sharing reductions that would incur if the people that took advantage of the BHP had enrolled in a Qualified Health Program (QHP) through the Marketplace instead. Essentially, the money the federal government would be spending on these families in the Marketplace, they are simply sending to the states offering the BHPs.

While not all states have taken advantage of this option, there are clear benefits for both the state and the individuals enrolling for health coverage. This presents a win-win situation. To see if your state offers a BHP, you can search by your state on the Marketplace website healthcare.gov.

Eligibility Team

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