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Medicaid Bridge Program

“Bridge Plans” and other similarly-named initiatives are euphemisms used to describe an aspect of the "Basic Health Program" where continuity of health insurance plan and healthcare providers is maintained for individual whose Medicaid eligibility fluctuates. The Basic Health Program was created by the Affordable Care Act (ACA) as an optional program to provide subsidies for individuals and families whose income is between 139% and 200% of the Federal Poverty Limit (FPL). The ability to provide coverage continuity for an individual going in and out of Medicare eligibility depends on how a state designs its Basic Health Program.

Individuals and families with income under 138% of the Federal Poverty Level (FPL) will be eligible for Medicaid while those with income between 100% and 400% of the FPL will be able to purchase subsidized plans from the exchange. Since economic circumstances and family size are subject to change, those families that are eligible for one program for a calendar year may find that their eligibility changes the next year. This movement between insurance programs is called “churning” and can be expensive and inconvenient for enrollees.

The Basic Health Program (BHP) or Bridge Plans are optional systems run at the state level. They are designed to address the needs of those who are likely to experience churning and provide them with stable health coverage. States can use federal subsidized money to extend health coverage options to families and individuals whose income falls between 139% and 200% of the FPL instead of requiring them to purchase plans through the exchange and, consequently, change insurance providers and doctors. It is estimated that about 7.5 million Americans fall into this income bracket and would be eligible for the BHP. One of the motivations for a bridge plan is the interest to prevent this population from suffering a disruption in care for a persistent health issue due to a change in insurance plan and health care providers.

For example, a family covered under Medicaid typically pays little in out-of-pocket costs for their health coverage. If their annual income goes up enough to require them to purchase their own coverage via the state exchange, the related premiums and co-pays could be as much as 3% of their income and lead to a reluctance to pursue needed healthcare services due to financial strains. Consequently, the Basic Health Program is offered as a way to make the transition easier.

Since Bridge Plans are optional and there is still some time until the 2014 expansion of the ACA, states are still deciding what form their Bridge Plans should take. They are examining their options and projecting how their programs could prevent churning. For instance, it is predicted that about 4.5 million California residents would be eligible for a BHP at some point during any given calendar year, but it is unknown how many of those would be ultimately be required to change or churn through health insurance programs as a result. It is possible that states will choose to provide some sort of Basic Health Program in combination with their Medicaid or exchange program, but at this point the scope and availability of the BHP remains unknown.

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