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Basic Health Program; Federal Funding Methodology for Program Years 2017 and 2018. Final methodology.

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    Summary

    This document details how federal payments were calculated for states operating a Basic Health Program in 2017-2018. It outlines the methods and data used to determine funding for low-income individuals accessing health coverage.

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    Area of Science:

    • Health Policy
    • Public Finance
    • Healthcare Economics

    Background:

    • The Affordable Care Act enables states to establish Basic Health Programs (BHPs).
    • BHPs provide subsidized health insurance to low-income individuals ineligible for Medicaid but unable to afford marketplace plans.
    • Accurate federal payment determination is crucial for BHP sustainability and state participation.

    Purpose of the Study:

    • To outline the methodology for calculating federal payments to states for Basic Health Programs.
    • To identify the data sources used in determining these payment amounts for program years 2017 and 2018.
    • To ensure transparency and accuracy in federal funding for BHP initiatives.

    Main Methods:

    • Description of the payment calculation formula based on eligible enrollee populations.
    • Identification of data sources, including enrollment data and premium information.
    • Explanation of adjustments and reconciliation processes for federal payments.

    Main Results:

    • Federal payments were determined based on specific methodologies applied to 2017 and 2018 program data.
    • The document specifies the exact data inputs required for accurate payment calculations.
    • Methodology ensures payments align with the cost of providing coverage to targeted low-income populations.

    Conclusions:

    • The methodology presented provides a clear framework for federal BHP payment determination.
    • Accurate data and consistent application of the methodology are essential for program integrity.
    • This document serves as a key resource for states and policymakers involved in Basic Health Programs.