Department of Health and Human Services, Centers for Medicare & Medicaid Services: Basic Health Program: State Administration of Basic Health Programs; Eligibility and Enrollment in Standard Health Plans; Essential Health Benefits in Standard Health Plans; Performance Standards for Basic Health Programs; Premium and Cost Sharing for Basic Health Programs; Federal Funding Process; Trust Fund and Financial Integrity
GAO-14-462R: Mar 27, 2014
GAO reviewed the Department of Health and Human Services, Centers for Medicare & Medicaid Services' (HHS) new rule on the Basic Health Program (BHP): state administration of basic health programs; eligibility and enrollment in standard health plans; essential health benefits in standard health plans; performance standards for basic health programs; premium and cost sharing for basic health programs; federal funding process; and trust fund and financial integrity. GAO found that (1) the final rule establishes the BHP, as required by section 1331 of the Affordable Care Act. The BHP provides states the flexibility to establish a health benefits coverage program for low-income individuals who would otherwise be eligible to purchase coverage through the Affordable Insurance Exchange (Exchange). The BHP complements and coordinates with enrollment in a qualified health plan through the Exchange, as well as with enrollment in Medicaid and the Children's Health Insurance Program. The final rule also sets forth a framework for BHP eligibility and enrollment, benefits, delivery of health care services, transfer of funds to participating states, and federal oversight. Additionally, this final rule amends another rule issued by the Secretary of the Department of Health and Human Services in order to clarify the applicability of that rule to the BHP; and (2) HHS complied with the applicable requirements in promulgating the rule.