Kentucky: No longer down with #BHP? It looks that way for now.


Back in May, I first wrote about news that two additional states, Oregon and Kentucky, had decided to join New York and Minnesota in launching a Basic Health Plan (BHP) program under a provision allowing them to do so in the Affordable Care Act:

The Basic Health Program (BHP) – section 1331 of the ACA — was envisioned as a solution, although most states did not establish a BHP. Under the ACA (aka Obamacare), states have the option to create a Basic Health Program for people with incomes a little above the upper limit for Medicaid eligibility, and for legal immigrants who aren’t eligible for Medicaid because of the five-year waiting period.

The way BHPs work, once established, is like so:

  • If you earn up to 138% FPL, you enroll in Medicaid.
  • If you earn 138 - 200% FPL, you enroll in a Basic Health Plan policy (BHP).
  • If you earn 200% FPL or higher, you enroll in a Qualified Health Plan policy (QHP).

Federal funding for BHP programs is supposed to be equal to 95% of the total amount of advance premium tax credits (APTC) and cost sharing reduction (CSR) assistance that the enrollees would otherwise have been eligible for had they otherwise enrolled in a QHP using the ACA exchange. Of course, the state itself can also throw in additional funding to make the BHP plans more generous if they wish.

The BHP programs in New York and Minnesota have been wildly successful, with around 100,000 residents enrolled in Minnesotacare and a whopping 1.1 million in New York's "Essential Plan" program as of this writing, and as recently as October the BHP launches appeared to be full steam ahead in both Oregon and Kentucky:

UPDATE 10/24/22: Here's the latest official info on the Kentucky BHP program...

​The Kentucky Department for Medicaid Services (DMS) is developing a Basic Health Program (BHP) in accordance with 42 CFR Part 600.

What is a BHP?

A BHP is a bridge between the Medicaid program and coverage through a qualified health plan on the state-based exchange or other commercial health insurance. It will provide more affordable options including no deductibles and lower premiums and cost sharing amounts. A BHP also has continuous enrollment so individuals can apply any time during the year. Find more information at Basic Health Program​>

Who is it for?

​Adults younger than 65 with incomes between 138 percent and 200 percent of ​the federal poverty level are eligible for the BHP.​

Unfortunately, it looks like that progress has screeched to a halt in KY. Via the Bluegrass Institute (h/t to @Phel175 for the heads up):

The Center for Open government has learned that the Beshear administration has paused their effort to stand up a government-sponsored “public option” health plan.

It's important to note that the BHP program isn't really a "public option" the way most people have defined it. This program is limited to a narrow slice of the population, for starters. More to the point, these are still privately administered health insurance policies.

In an email obtained through Kentucky’s open records statutes, the Department for Medicaid Services informed their “BHP Partners” that “after further consideration, Kentucky has placed development of a Basic Health Program on hold.”

...Digging a little deeper, we uncovered that the General Assembly had tasked CHFS with developing a BHP:

In 2021, both houses of the legislature unanimously passed — and Governor Beshear signed — a joint resolution “directing the Cabinet for Health and Family Services to establish a work group to assess the feasibility of implementing a bridge insurance program.” House Speaker Pro Tempore David Meade, R-Stanford, was the resolution’s primary sponsor; Rep. Moser was the first listed co-sponsor.

...That post continued:

At some point during the ‘22 session, someone or some organization took the time to educate legislators on what exactly a BHP was designed to do: compete within the private exchange marketplace., BHPs don't "compete" with private insurance carriers...because it's still private insurance carriers (usually the same ones) providing the BHP coverage. The main difference is in how the policies are structured, paid for and enrolled in, but they're still private healthcare coverage mainly paid for with federal public funding.

The budget bill, which has the force of law for the two-year biennium, included language prohibiting the Beshear administration from “exercising the state’s option to develop a basic health program…without first obtaining specific authorization from the General Assembly.”

It’s possible that policymakers like Moser didn’t fully understand what they were signing onto. It happens all the time in the legislature. Thankfully, members involved in writing the budget put the brakes on it.

As an aside, the "thankfully" bit may seem a bit curious until you take a look at the Bluegrass Institute's mission statement:

Our vision at the Bluegrass Institute for Public Policy Solutions is to move Kentucky from dependency to prosperity by leading our commonwealth forward on the policy issues that advance free markets, expand liberty and result in smaller, more transparent government.

The Beshear administration has now applied the brakes too. Their email, however, did leave open the possibility it would “reach out if (they) decide to restart the initiative.”

(sigh) Stay far as I know, Oregon (which still holds a Democratic trifecta) is still proceeding.