Home > Obamacare > Affordable Care Act’s Basic Health Program

Affordable Care Act’s Basic Health Program

Minnesota, New York, Oregon, and DC offer BHPs for low-income enrollees who earn too much to qualify for Medicaid.

Author: Louise Norris

Updated July 1, 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 have Basic Health Programs:

Minnesota (MinnesotaCare)
Oregon (OHP Bridge)
District of Columbia (Healthy DC Plan)
New York (the Essential Plan)

Legislation was introduced in Connecticut in early 2026 to create a Basic Health Program, but it did not advance.⁴

However, Colorado enacted legislation in 2026 that calls for the state to conduct a study on the feasibility of creating a Basic Health Program.⁵

New York’s Essential Plan has changed over time: It was a Basic Health Program for several years, but its authority switched from ACA Section 1331 (BHP) to Section 1332 (innovation waiver) in 2024.⁶ At that point, Essential Plan eligibility was extended to 250% FPL.

However, due to federal funding cuts, the state reverted to a BHP starting in July 2026. As a result, the Essential Plan returned to its original 200% FPL income limit,⁷ and about 450,000 people were dropped from Essential Plan coverage.⁸

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 2026.⁹

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, 2024.¹⁰ But as noted above, New York has reverted to a BHP as of July 2026.⁷

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 1992,¹¹ but the program transitioned to a BHP in 2015.

More than 87,000 people were enrolled in MinnesotaCare as of June 2026. Enrollment had been higher in 2025, with more than 106,000 enrollees as of December 2025.¹² But premiums increased when federal subsidy enhancements expired at the end of 2025, resulting in lower enrollment for 2026.

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.¹³
Premium: In 2026, MinnesotaCare has monthly premiums that range from $0 to $80, depending on the enrollee’s income.¹³ Premiums were significantly lower in 2025, but increased in 2026 due to the expiration of federal subsidy enhancements.¹⁴
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.
Managed care: Minnesota contracts with eight insurers that provide MinnesotaCare benefits to enrollees.¹⁵

Oregon’s OHP Bridge: The OHP Bridge program became available starting in July 2024. Nearly 47,000 people were enrolled in OHP Bridge as of June 2026.¹⁶

Cost-sharing: OHP Bridge does not have any cost-sharing.¹⁷
Premiums: OHP Bridge does not have any premiums.¹⁷
Eligibility: Coverage is available to adults who aren’t eligible for Medicaid, and whose household income isn’t more than 200% of FPL.
Coordinated care: Oregon contracts with 15 Coordinated Care Organizations (CCOs) that provide OHP Bridge benefits to nearly all enrollees, with CCO availability that varies by area¹⁸ (American Indian and Alaska Native enrollees use a fee-for-service model instead).¹⁹

New York’s Essential Plan: New York’s Essential Plan covered nearly 1.7 million people as of May 2026.²⁰ But as noted above, about 450,000 people were disenrolled from the Essential Plan as of July 2026, due to federal funding cuts.⁸

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.²¹ For enrollees with cost-sharing, maximum out-of-pocket limits vary from $200 to $2,000, depending on the enrollee’s income.²²
Premiums: There are no premiums for the Essential Plan as of 2026.²³
Eligibility: Available to adults with household income above 138% of the FPL, but not more than 200% of FPL.²⁴
Managed care: New York contracts with 14 insurers to offer Essential Plan coverage.²⁵

Legislation was introduced in New York in late 2025 that would have allowed people with higher incomes to purchase Essential Plan coverage by paying a monthly premium, and would have allowed large employers to purchase Essential Plan coverage for their employees. But the bill did not advance.²⁶

Healthy DC Plan: Washington, DC launched the Healthy DC Plan in the fall of 2025, with coverage effective in January 2026.²⁷ The District’s BHP blueprint approval was approved by CMS in October 2025.²⁸ BHP enrollment is available year-round. But by the end of the open enrollment period for 2026 coverage, 15,722 people were enrolled in the Healthy DC Plan.²⁹

Cost-sharing: There are no out-of-pocket costs for covered services.³⁰
Premiums: There are no premiums for Healthy DC Plan coverage.³⁰
Eligibility: Available to adults with household income above 138% FPL, up to 200% FPL.³⁰
Managed care: DC contracts with three insurers to offer Healthy DC Plan coverage (AmeriHealth Caritas, CareFirst BlueCross BlueShield, and MedStar Family Choice).³¹

From 2010 through 2025, DC provided Medicaid to residents with household income up to 215% FPL.³² But that ended on Dec. 31, 2025, and Medicaid eligibility in DC dropped to 138% FPL starting in January 2026³³ (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,³⁴ including automatically transferring almost 16,000 people from expanded Medicaid to the Healthy DC Plan.³⁵

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.

<< Previous Post Next Post >>

Footnotes