Alyssa Lane
Health insurance in the United States is provided through privately purchased insurance, social insurance, or government-funded social welfare programs like Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). While the Affordable Care Act (ACA) has increased access to health insurance, the uninsured rate remains high at 10.9% in 2019, with non-elderly adults, low-income families, and minorities being the most affected. To address this, some states have expanded their Medicaid programs or created additional state-funded subsidy programs to enhance affordability. Notably, New York, Minnesota, and Oregon have implemented Basic Health Programs (BHPs), offering comprehensive health coverage with minimal premiums to residents with incomes up to 200% of the federal poverty level (FPL). These BHPs aim to provide more affordable and continuous care for low-income individuals who do not qualify for Medicaid or CHIP.
| Characteristics | Values |
|---|---|
| States with Basic Health Programs (BHPs) | New York, Minnesota, and Oregon |
| States with state-funded health insurance subsidy programs | Nine states |
| States with expanded Medicaid programs | Washington, DC |
| Federal funding for states with BHPs | 95% of the amount of premium tax credits and cost-sharing reductions |
| Eligibility for BHPs | Income between 133% and 200% of the federal poverty level (FPL); in New York, eligibility was extended to 250% of FPL in April 2024 |
| Eligibility for state-funded subsidies | Varies by state |
Explore related products
What You'll Learn
Medicaid expansion
The Affordable Care Act (ACA) has allowed for the expansion of Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($21,597 for an individual in 2025). This has provided states with an enhanced federal matching rate (FMAP) for their expansion populations. However, the U.S. Supreme Court has ruled that Medicaid expansion is voluntary with states, meaning some states have chosen not to expand their Medicaid programs.
States that have expanded their Medicaid programs cover all people with household incomes below a certain level. Qualification for Medicaid coverage depends on whether the state has expanded its program, with qualification criteria including income, household size, disability, family status, and other factors. In states that have expanded Medicaid coverage, qualification is based on income alone. If a household income is below 133% of the federal poverty level (which works out to be 138%), then that household qualifies.
Some states have chosen to implement a Basic Health Program (BHP), which is a health benefits coverage program for low-income residents who would otherwise purchase coverage through the Health Insurance Marketplace. BHPs are not the same as additional state-funded subsidies, but they do provide comprehensive health coverage, with free or very low premiums, to residents with incomes up to 200% of FPL. States that have implemented BHPs include New York, Minnesota, and Oregon.
For those in states that have not expanded their Medicaid programs, there are still options for coverage. Each state has coverage options that could work for those with children, who are pregnant, or who have a disability. Additionally, individuals can apply for a "Catastrophic" health plan if they are under 30 years old.
Therapists and Medical Insurance: Are They Specialists?
You may want to see also
Explore related products
Affordable Care Act
The Affordable Care Act, also known as Obamacare, is a comprehensive health care reform law enacted in March 2010. The act includes delivery system reforms intended to constrain costs and improve quality. The individual insurance market was radically overhauled, and many of the law's regulations applied specifically to this market. The law also made delivery system changes that affected most of the health care system.
The Affordable Care Act created an income-based federal subsidy program for people who buy their own health insurance. In every state, federal premium tax credits (premium subsidies) are available to reduce the amount that most enrollees pay for their coverage. Additionally, cost-sharing reductions are available to limit out-of-pocket costs for lower-income enrollees. The law provides consumers with subsidies ("premium tax credits") that lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL).
Section 1331 of the Affordable Care Act gives states the option of creating a Basic Health Program (BHP), a health benefits coverage program for low-income residents who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace. BHPs provide very comprehensive health coverage, with free or very low premiums, to residents with income up to 200% of FPL. As of May 2025, three states (New York, Minnesota, and Oregon) have implemented BHPs.
The Affordable Care Act also expanded the Medicaid program to cover more people. The act includes Medicare payment changes to discourage hospital-acquired conditions and readmissions, bundled payment initiatives, the Center for Medicare and Medicaid Innovation, the Independent Payment Advisory Board, and accountable care organizations. From 2017 onwards, states can apply for a "waiver for state innovation", which allows them to implement alternative health systems that provide insurance that is at least as comprehensive and affordable as the ACA.
Enrolling in High-Deductible Medical Insurance: A Step-by-Step Guide
You may want to see also
Explore related products
State-funded subsidies
In the United States, health insurance helps pay for medical expenses through private insurance, social insurance, or government-funded social welfare programs like Medicaid and the Children's Health Insurance Program (CHIP). These programs provide assistance to people who cannot afford health coverage.
The Affordable Care Act (ACA) created an income-based federal subsidy program for people who buy their own health insurance. Federal premium tax credits (premium subsidies) are available in every state to reduce coverage costs, and cost-sharing reductions are available to limit out-of-pocket expenses for lower-income enrollees.
However, some states have also implemented additional state-funded subsidy programs that make coverage even more affordable than federal subsidies alone. Eligibility for these state-funded subsidies is typically based on how an individual's or household's income compares to the federal poverty level (FPL). As of May 2025, nine states have such programs in place.
Three states, New York, Minnesota, and Oregon, have Basic Health Programs (BHPs), which are distinct from state-funded subsidies but provide comprehensive health coverage with free or very low premiums to residents with incomes up to 200% of FPL. New York has extended eligibility to include residents with incomes up to 250% of FPL. Washington, DC, also provides Medicaid coverage to adults with incomes up to 215% of FPL, which is significantly higher than the limit used in most states.
Assisted Suicide: Medical Insurance's Role and Relevance
You may want to see also
Explore related products
$14.39 $16.99
$39.99 $49.99
$12.99 $19.99
Basic Health Program
The Basic Health Program (BHP) is an alternative form of coverage authorized by Section 1331 of the Affordable Care Act (ACA). It is a health benefits coverage program for low-income residents who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace. The BHP gives states the ability to provide more affordable coverage for low-income residents and improve continuity of care for people whose income fluctuates above and below Medicaid and Children's Health Insurance Program (CHIP) levels.
Through the BHP, states can provide coverage to individuals who are citizens or lawfully present non-citizens, who do not qualify for Medicaid, CHIP, or other minimum essential coverage, and have income between 133 percent and 200 percent of the federal poverty level (FPL). Lawfully present non-citizens who have an income that does not exceed 133 percent of FPL but are unable to qualify for Medicaid due to their non-citizen status are also eligible for the BHP.
The BHP is not the same as additional state-funded subsidies, but it does provide comprehensive health coverage, with free or very low premiums, to eligible residents. A state that operates a BHP will receive federal funding equal to 95 percent of the amount of the premium tax credits and the cost-sharing reductions that would have otherwise been provided to eligible individuals if they had enrolled in qualified health plans (QHPs) through the Marketplace.
As of 2025, three states have implemented a BHP: Minnesota, New York, and Oregon. Minnesota has implemented a BHP since January 1, 2015, New York implemented a BHP in April 2015 and suspended it in April 2024, and Oregon implemented a BHP in July 2024. New York and Minnesota offered substantially more generous coverage than would have otherwise been available in their marketplaces. Other states such as Kentucky and Massachusetts had been working on creating a BHP, but it is unclear whether they will revive it.
Get Medical Insurance for Visitor Visa: What You Need to Know
You may want to see also
Explore related products
Eligibility criteria
Medicaid is a joint federal and state program that provides health coverage to Americans from certain groups, including children, pregnant women, parents, seniors, and individuals with disabilities. States have some flexibility in determining eligibility criteria for Medicaid, and these criteria vary across states. Here is an overview of the general eligibility criteria for Medicaid and other basic medical insurance programs offered by states:
Income
Income is a key factor in determining eligibility for basic medical insurance provided by states. Medicaid is specifically designed to provide coverage for individuals with low incomes. Each state sets its own income standards, which are typically expressed as a percentage of the Federal Poverty Level (FPL). For example, in 2018, the FPL for a family of four was $25,100 in most states, but it was higher in Alaska and Hawaii. States may also use dollar amounts based on household size instead of percentages of the FPL to determine eligibility.
Household Size
The number of people in your household can impact your eligibility for state-provided basic medical insurance. Some states take into account the size of your household when determining eligibility and setting income standards.
Health Status
Your health status may also be a factor in determining eligibility. Some states have eligibility criteria based on blindness, disability, or age (65 and older). Additionally, certain states provide coverage for individuals with specific health needs, such as pregnant women or individuals requiring nursing facility services.
Citizenship and Immigration Status
Citizenship and immigration status are important considerations for eligibility. To be eligible for Medicaid, individuals generally need to be U.S. citizens, U.S. nationals, or lawfully present non-citizens. Non-citizen U.S. nationals typically include those born in American Samoa or born abroad with at least one American Samoan parent. States may also have specific requirements regarding immigration status for eligibility in their basic health programs.
State Residency
To be eligible for basic medical insurance provided by a particular state, individuals usually need to be residents of that state. Each state's Medicaid agency determines eligibility for residents within that state.
Age
Age can be a factor in eligibility, as previously mentioned, with certain groups, such as seniors or children under a certain age, being specifically targeted for coverage.
It is important to note that the eligibility criteria can vary from state to state, and some states may have additional or more specific requirements. Individuals should refer to their specific state's Medicaid agency or official websites to determine their unique eligibility criteria and requirements.
Medical Insurance and Tax Deductions: What You Need to Know
You may want to see also
Frequently asked questions
As of May 2025, three states—New York, Minnesota, and Oregon—have Basic Health Programs (BHPs) that provide comprehensive health coverage with free or very low premiums to residents with incomes up to 200% of the federal poverty level (FPL).
The BHP is a health benefits coverage program for low-income residents who would otherwise purchase coverage through the Health Insurance Marketplace. States that implement a BHP will receive federal funding equal to 95% of the amount of the premium tax credits and cost-sharing reductions that would have been provided to eligible individuals through the Marketplace.
Eligibility for the BHP varies by state. In general, the BHP is designed for citizens or lawfully present non-citizens who do not qualify for Medicaid, CHIP, or other minimum essential coverage and have incomes between 133% and 200% of the federal poverty level (FPL).
In addition to state-funded BHPs, nine states have implemented additional state-funded subsidy programs that make coverage more affordable than with federal subsidies alone. The Affordable Care Act (ACA) also offers an income-based federal subsidy program with premium tax credits and cost-sharing reductions available in every state.
