Amended by section 10104 of the Manager’s Amendment. Directs HHS to establish a Basic Health Plan Program in which States may contract to offer 1 or more standard health plans offering essential health benefits to eligible individuals – those who are under age 65, are not eligible for Medicaid, generally have incomes between 133 and 200 percent of the Federal Poverty Level, are not eligible for minimum essential coverage, or are eligible for an employer-sponsored plan that is not affordable – in lieu of covering them via the Exchange.
Establishes HHS criteria under which the State must demonstrate that Basic Health Plan Program’s monthly premium does not exceed that of the applicable second lowest cost silver plan – after any applicable reductions, such as from the advance premium tax credit – and that cost-sharing does not exceed corresponding levels associated with specified Exchange metallic tiers depending on income. Sets parameters for the contracting process, including for negotiation with entities offering standard health plans for the inclusion of innovative features, such as care coordination.
Specifies HHS funding level at 95 percent of the premium tax credits and cost-sharing reductions that would have been provided for the fiscal year to eligible individuals enrolled in standard health plans in the State if such eligible individuals were allowed to enroll in Qualified Health Plans through an Exchange.