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Affordable Care Act’s Basic Health Program

Minnesota, Oregon, and DC offer BHPs for low-income enrollees who earn too much to qualify for Medicaid. New York offers a similar program, but it's not currently considered a BHP.

Author: Louise Norris | Date Posted: February 2, 2026

What is the Basic Health Program?

The Basic Health Program (BHP) – section 1331 of the ACA – allows states to create a coverage program for adults with household income between 138% and 200% of the federal poverty level (FPL).¹ Like Medicaid, enrollment in a BHP is available year-round for eligible applicants.

The ACA's Medicaid expansion, which most states have implemented,² covers adults under age 65 with household income up to 138% of FPL. In states that implement a BHP, eligibility picks up where Medicaid expansion ends, and extends to 200% of FPL.

States can fund a BHP using federal funding that would otherwise have been spent on Marketplace premium subsidies for those enrollees. The federal government will give the state 95% of the amount the federal government would otherwise have spent on subsidies, and the state can supplement that funding with additional state funding.³ But most states have not established a BHP.

Which states have Basic Health Programs?

As of mid-2026, three states and the District of Columbia will have Basic Health Programs:

Minnesota (MinnesotaCare) — already in effect
Oregon (OHP Bridge) — already in effect
District of Columbia (Healthy DC Plan) — took effect Jan. 1, 2026⁴
New York (the Essential Plan) — already in effect, but technically not a BHP from April 2024 through June 2026.

New York's Essential Plan was previously a Basic Health Program, but its authority switched from ACA Section 1331 (BHP) to Section 1332 (innovation waiver) in 2024.⁵ At that point, Essential Plan eligibility was extended to 250% FPL.

However, New York has announced that due to federal funding cuts, the state plans to revert to a BHP starting in July 2026. At that point, the Essential Plan will return to its original 200% FPL income limit.⁶

How long have states operated Basic Health Programs?

The ACA's Basic Health Program was originally scheduled to begin January 1, 2014, but was postponed until 2015. To date, three states and DC have implemented a BHP: Minnesota's BHP was effective in January 2015 (see Minnesota's BHP blueprint), New York's took effect in January 2016 (see New York’s BHP blueprint), Oregon's took effect in July 2024 (see Oregon's BHP blueprint), and DC's took effect in January 2026.⁷

New York received federal permission in 2024 to switch its BHP to a section 1332 innovation waiver program, with eligibility expanded to cover people up to 250% of the FPL. That change took effect on April 1, 2024.⁸ But as noted above, New York has begun the process of reverting to a BHP, and plans to have that change in place by July 2026.⁶

Current BHP coverage details

Here's an overview of how BHP coverage works in Minnesota, Oregon, New York, and the District of Columbia:

MinnesotaCare: Minnesota has operated MinnesotaCare since 1992,⁹ but the program transitioned to a BHP in 2015. About 105,000 people are enrolled in MinnesotaCare.¹⁰

Cost-sharing: Some enrollees, including children, pregnant women, and Native Americans, don't pay any cost-sharing. For other adults, there is modest cost-sharing for various services.¹¹
Premium: In 2025, MinnesotaCare has no premium if the enrollee's household income is less than 169% of FPL. Between 160% and 200% of FPL, monthly premiums range from $4 to $28.¹² These premiums will increase in 2026 if the American Rescue Plan's subsidy enhancements are allowed to expire.
Eligibility: Coverage is available to adults who aren't eligible for Medicaid (Medical Assistance) and whose household income isn't more than 200% of FPL.

Oregon's OHP Bridge: The OHP Bridge program became available starting in July 2024. More than 36,000 people were enrolled in OHP Bridge as of December 2025.¹³

Cost-sharing: OHP Bridge does not have any cost-sharing.¹⁴
Premiums: OHP Bridge does not have any premiums.¹⁴
Eligibility: Coverage is available to adults who aren't eligible for Medicaid, and whose household income isn't more than 200% of FPL.

New York's Essential Plan: New York's Essential Plan covered more than 1.7 million people as of early 2026.¹⁵

Cost-sharing: Enrollees with household income up to 150% FPL have no out-of-pocket costs. Enrollees above that level pay modest cost-sharing for some services.¹⁶ For enrollees with cost-sharing, maximum out-of-pocket limits vary from $200 to $2,000, depending on the enrollee's income.¹⁷
Premiums: There are no premiums for the Essential Plan as of 2026.¹⁶
Eligibility: Currently available to adults with household income above 138% of the FPL, but not more than 250% of FPL. Starting in July 2026, New York plans to reduce the eligibility limit to 200% of FPL.¹⁸
Legislation in committee in New York in early 2026 would allow people with higher incomes to purchase Essential Plan coverage by paying a monthly premium, and would allow large employers to purchase Essential Plan coverage for their employees. The bill's future is uncertain.¹⁹

Healthy DC Plan: Washington, DC launched the Healthy DC Plan in the fall of 2025, with coverage effective in January 2026.²⁰ The District's BHP blueprint approval was approved by CMS in October 2025.²¹

Cost-sharing: There are no out-of-pocket costs for covered services.²²
Premiums: There are no premiums for Healthy DC Plan coverage.²²
Eligibility: Available to adults with household income above 138% FPL, up to 200% FPL.²²

From 2010 through 2025, DC provided Medicaid to residents with household income up to 215% FPL.²³ But that ended on Dec. 31, 2025, and Medicaid eligibility in DC dropped to 138% FPL starting in January 2026²⁴ (that's the normal Medicaid expansion eligibility limit that's used in the 40 states that have expanded Medicaid under the ACA).

DC worked to make the transition to the Healthy DC Plan as seamless as possible for people with household income between 139% and 200% FPL,²⁵ including automatically transferring almost 16,000 people from expanded Medicaid to the Healthy DC Plan.²⁶

But for DC residents with income between 200% and 2015% of FPL, Medicaid is no longer available and neither is the Healthy DC Plan. These enrollees needed to switch to a Marketplace plan offered by DC Health Link.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written hundreds of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.

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