State Basic Health Programs (BHPs) are optional low-income health coverage plans that states can establish under the Affordable Care Act for residents who earn too little to qualify for Medicaid but have no affordable coverage through the standard health insurance Marketplace. The federal government funds these programs by paying states 95% of the tax credits and cost-sharing subsidies that enrollees would otherwise receive through Marketplace plans, eliminating the state budget burden of traditional Medicaid expansion. Since the option became available in 2010, only four jurisdictions have established BHPs: Minnesota (MinnesotaCare), Oregon (OHP Bridge), Washington, DC (Healthy DC Plan), and New York (Essential Plan), with the newest programs launching in 2024 and 2026. If you live in one of these states or DC, a BHP may offer you coverage at minimal or no cost. If you live elsewhere, this option does not currently exist in your state.
Table of Contents
- Who qualifies for a Basic Health Program
- Where BHPs are available now
- What BHP coverage includes and what it costs
- BHP versus Medicaid and Marketplace coverage
- How to enroll if your state offers a BHP
- Frequently Asked Questions
Who qualifies for a Basic Health Program
BHPs serve people whose household income falls between the Medicaid cutoff and 200% of the federal poverty level—roughly $27,700 for an individual or $56,900 for a family of four in 2026. This population often falls into a coverage gap: they don't qualify for Medicaid because they earn slightly too much, but they can't afford unsubsidized marketplace plans because their income is too low for meaningful tax credits.
Lawfully present immigrants who cannot qualify for Medicaid due to immigration status can enroll in BHPs in participating states. This includes people on valid visa categories and others with legal status who fall outside the current Medicaid rules. You'll need to provide proof of income and legal residency to verify eligibility.
Where BHPs are available now
As of 2026, only Minnesota, Oregon, Washington, DC, and New York operate Basic Health Programs. MinnesotaCare, the oldest program, has covered more than 87,000 people as of May 2026, while the newest programs—Oregon's OHP Bridge (launched July 2024), DC's Healthy DC Plan (January 2026), and New York's Essential Plan (reinstated July 2026)—are still in early growth phases. If you live in any other state, your state government has chosen not to establish a BHP, and this coverage option is not available to you.
You would instead rely on Medicaid (if your income qualifies) or Marketplace coverage with any subsidies your income level provides. No timeline exists for additional states to adopt BHPs, though the programs continue to operate in the four current jurisdictions.
What BHP coverage includes and what it costs
All Basic Health Programs must cover the ten essential health benefits required by the Affordable Care Act, with premiums and out-of-pocket costs capped at levels comparable to the lowest-cost Marketplace silver plan in each state. This means you get hospital care, emergency services, prescription drugs, and other standard medical benefits.
The cost structure varies by program and your income. Oregon's OHP Bridge operates at zero cost—no premiums or out-of-pocket expenses for enrolled residents. Minnesota's MinnesotaCare charges monthly premiums ranging from $0 to $80 depending on your household income, with children and pregnant women paying no cost-sharing. New York and DC pricing follows the Marketplace cap rules but will be lower than private Marketplace plans at your income level.
BHP versus Medicaid and Marketplace coverage
The key difference is funding. Medicaid is a joint federal-state program where states manage enrollment, set benefit rules, and cover the cost. A BHP is instead funded by the federal government, which pays states the premium and subsidy money directly, so states don't bear the ongoing financial burden. In practice, this often means BHP premiums and costs are lower than what Medicaid might charge in your state for the same population.
Compared to a Marketplace plan, a BHP offers coverage to people whose income falls in the gap—too high for Medicaid but too low to receive substantial Marketplace subsidies. If you qualify for both Medicaid and a BHP (only in the four states that offer BHPs), you'll likely choose based on which program has simpler enrollment or lower out-of-pocket costs in your jurisdiction.
How to enroll if your state offers a BHP
Check your state's health program website to see if you live in Minnesota, Oregon, New York, or Washington, DC. MinnesotaCare enrolls through MNsure (Minnesota's Marketplace), Oregon enrolls through Oregon Health Plan, New York enrolls through the Essential Plan application, and DC enrolls through Healthy DC directly. Each program has its own open enrollment periods and application process.
Prepare documentation of your household income (recent pay stubs, tax return, or self-employment records) and proof of legal residency or citizenship. Most programs allow year-round enrollment rather than restricting you to annual open enrollment. Contact your state's health department or insurance marketplace if you're unsure whether you qualify or how to apply—they can walk you through the process at no cost.
Frequently Asked Questions
Can I have a Basic Health Program if I already have Medicaid?
If you qualify for Medicaid, most states will require you to enroll in Medicaid first before considering a BHP. These programs are designed for the gap population—people ineligible for Medicaid. In the rare case where you qualify for both, your state's specific rules govern which one you can choose.
If my state doesn't have a BHP, will one be created soon?
No timeline has been announced. Fewer than ten percent of states have adopted BHPs despite the option being available since 2010, suggesting states prefer other coverage mechanisms or face barriers to implementation. Your state's coverage options are Medicaid (if your income qualifies) and the Marketplace with available subsidies.
What happens if my income changes while I'm enrolled?
Income changes must be reported and can affect your eligibility and cost-sharing tier. Each program has different rules for how quickly changes take effect. Contact your program's customer service to update your income and understand any change to your premium or out-of-pocket costs.