Institutional Federal Compliance Report 2021

STATE OF NEW YORK

Schedule of Findings and Questioned Costs

Year ended March 31, 2018

Federal Agency:

U.S. Department of Health and Human Services

Federal Program:

Basic Health Program (Affordable Care Act) (93.640)

Federal Award Numbers:

BHPFFY2016-17

Federal Award Years:

2016 and 2017

State Agency:

Department of Health

Reference:

2018-028

Criteria Section 1331 of the Patient Protection and Affordable Care Act, (Pub. L. 111-148), and the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111.152, enacted March 30, 2010), which are collectively referred to as the Affordable Care Act, gives states the option of creating a Basic Health Program (BHP), a health benefits coverage program for low-income residents who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace. The program is for specified individuals who do not qualify for Medicaid but whose income does not exceed 200% of the federal poverty level (FPL). Further, Title 42 U.S. Code of Federal Regulations Part 600 (42 CFR 600 ), Administration, Eligibility, Essential Health Benefits, Performance Standards, Service Delivery Requirements, Premium and Cost Sharing Allotments, and Reconciliation , section 600.305(a) states the State must determine individuals to be eligible to enroll in a standard health plan if they:

(1) Are residents of the State.

(2) Have household income which exceeds 133% but does not exceed 200% of the FPL for the applicable family size, or, in the case of an individual who is a lawfully present noncitizen, ineligible for Medicaid or CHIP due to such immigration status, whose household income is between zero and 200% of the FPL for the applicable family size.

(3) Are not eligible to enroll in minimum essential coverage (other than a standard health plan). If an individual meets all other eligibility standards, and

(i) Is eligible for, or enrolled in, coverage that does not meet the definition of minimum essential coverage, including Medicaid that is not minimum essential coverage, the individual is eligible to enroll in a standard health plan without regard to eligibility or enrollment in Medicaid; or (ii) Is eligible for Employer Sponsored Insurance (ESI) that is unaffordable (as determined under Section 36B(c)(2)(C) of the Internal Revenue Code), the individual is eligible to enroll in a standard health plan.

(4) Are 64 years of age or younger.

(5) Are either a citizen or lawfully present noncitizen.

83

(Continued)