1331 Waivers: State Comparisons to Create a Basic Health Plan

State policymakers across the nation are looking to increase access to affordable health care coverage – especially as state Medicaid agencies begin unwinding from the COVID-19 public health emergency. One way that states can advance coverage options is through the creation of a state-sponsored Basic Health Program (BHP) using a waiver outlined in Section 1331 of the Affordable Care Act (ACA). The goal of a 1331 waiver is to provide sustainable and affordable coverage for individuals between 138 and 200% of the federal poverty level, many of whom regularly “churn” between Medicaid and private insurance due to income fluctuations. 

USofCare engaged with the development of the Bridge Plan in Oregon, which recently joined Minnesota and New York in creating a BHP. In the chart below, we compare how these states have leveraged 1331 waivers to create programs that meet the needs of people with incomes just above the Medicaid eligibility threshold. While they vary slightly in design, cost, and benefits covered from state to state, all three are alike in that they have expanded coverage and affordable care to eligible people.