AN ACT CONCERNING A BASIC HEALTH PROGRAM.

House of Representatives
sHB5559 / File No. 443 1

General Assembly File No. 443
February Session, 2026 Substitute House Bill No. 5559

House of Representatives, April 7, 2026

The Committee on Human Services reported through REP.
GILCHREST of the 18th Dist., Chairperson of the Committee on
the part of the House, that the substitute bill ought to pass.

AN ACT CONCERNING A BASIC HEALTH PROGRAM.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:

Section 1. (NEW) (Effective July 1, 2026) (a) As used in this section and 1
sections 2 to 4, inclusive, of this act: 2
(1) "Affordable Care Act" has the same meaning as provided in 3
section 38a-1080 of the general statutes; 4
(2) "Eligible individual" means a state resident who (A) is under sixty-5
five years of age, (B) has household income exceeding one hundred 6
thirty-three per cent of the federal poverty level but not exceeding two 7
hundred per cent of the federal poverty level, (C) is otherwise ineligible 8
for medical assistance programs established pursuant to chapter 319v of 9
the general statutes, and (D) is otherwise eligible to enroll in a qualified 10
health plan, as defined in section 38a -1080 of the general statutes, on 11
Access Health Connecticut; and 12
(3) "Basic health program" means a health care program authorized 13
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under Section 1331 of the Affordable Care Act for eligible individuals 14
that is funded by federal payments to the state amounting to ninety-five 15
per cent of the health insurance premium tax credits and cost -sharing 16
reductions that would have otherwise been provided to, or on behalf of, 17
eligible individuals under the Affordable Care Act. 18
(b) On and after October 1, 2026, the Commissioner of Social Services, 19
in consultation with the Office of Policy and Management and based 20
upon the recommendations of the working group established pursuant 21
to section 3 of this act, shall seek any necessary approvals from the 22
federal government to establish a basic health program and take all 23
necessary actions to maximize federal funding. 24
(c) The commissioner shall, in accordance with the Affordable Care 25
Act, coordinate the administration of, and provision of benefits under, 26
the basic health program with the state medical assistance programs. To 27
the extent permissible under the Affordable Care Act, medical 28
assistance provided through the basic health program shall include the 29
benefits, limits on cost -sharing and other consumer safeguards that 30
apply to the state medical assistance programs. 31
(d) If the commissioner determines that the cost of medical assistance 32
provided to eligible individuals in the basic health program will exceed 33
federal subsidies, or if changes in federal law, regulations or the 34
administration of federal law or regulations affects funding, eligibility 35
for or administration of the program, the commissioner, in consultation 36
with the Office of Policy and Management, may develop a plan to 37
respond to such changes. To the extent that federal funds received under 38
the Affordable Care Act for the basic health program exceed the cost of 39
medical assistance that would otherwise be provided to eligible 40
individuals, the commissioner shall use such funds to reduce the 41
premiums and cost -sharing of, or provide additional benefits for, 42
eligible individuals in accordance with 42 USC 18051, as amended from 43
time to time. 44
(e) The Commissioner of Social Services shall forward any 45
application for federal approval of or changes to the basic health 46
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program to the joint standing committees of the General Assembly 47
having cognizance of matters relating to appropriations and the budgets 48
of state agencies and human services and to the working group 49
established pursuant to section 3 of this act not later than thirty days 50
before seeking federal approval for the program. 51
(f) Not later than January 1, 2027, every six months thereafter through 52
January 1, 2030, and annually thereafter, the commissioner shall submit 53
a report, in accordance with the provisions of section 11-4a of the general 54
statutes, to the joint standing committees of the General Assembly 55
having cognizance of matters relating to appropriations and the budgets 56
of state agencies, human services and insurance and real estate. The 57
report shall contain a narrative description of the operations, activities 58
and finances of the basic health program and any supporting 59
documentation or data for the immediately preceding reporting period. 60
Sec. 2. (NEW) ( Effective July 1, 2026 ) There is established an account 61
to be known as the "basic health program account", which shall be a 62
separate, nonlapsing account. The account shall contain any moneys 63
required by law to be deposited in the account. Moneys in the account 64
shall be expended by the Department of Social Services solely for the 65
purposes of operating a basic health program in accordance with the 66
Affordable Care Act and section 1 of this act. 67
Sec. 3. (NEW) (Effective from passage) (a) The Commissioner of Social 68
Services shall establish a working group to oversee the design of the 69
basic health program established pursuant to sections 1 and 2 of this act. 70
(b) The working group shall consist of: 71
(1) The Connecticut Healthcare Advocate, or the advocate's designee; 72
(2) The Insurance Commissioner, or the commissioner's designee; 73
(3) The Commissioner of Social Services, or the commissioner's 74
designee; 75
(4) The executive director of the Commission on Racial Equity in 76
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Public Health, or the executive director's designee; 77
(5) The State Comptroller, or the comptroller's designee; 78
(6) The Secretary of the Office of Policy and Management, or the 79
secretary's designee, who shall serve as a chairperson; 80
(7) The speaker of the House of Representatives, the president pro 81
tempore of the Senate, the majority leader of the House of 82
Representatives, the majority leader of the Senate, the minority leader 83
of the House of Representatives, and the minority leader of the Senate, 84
or their designees; 85
(8) The House and Senate chairpersons of the joint standing 86
committee of the General Assembly having cognizance of matters 87
relating to human services, who, along with the Secretary of the Office 88
of Policy and Management, or the secretary's designee, shall serve as 89
chairpersons; 90
(9) The House and Senate chairpersons of the joint standing 91
committee of the General Assembly having cognizance of matters 92
relating to insurance and real estate, or their designees; 93
(10) The chief executive officer of Access Health Connecticut; 94
(11) Three health insurance experts from the nonprofit and academic 95
communities with demonstrated knowledge about health plan design 96
and actuarial practices, appointed by the chairpersons of the working 97
group; and 98
(12) Any other members the chairpersons of the working group deem 99
necessary. 100
(c) Any member of the working group appointed under subdivisions 101
(11) and (12) of subsection (b) of this section may be a member of the 102
General Assembly. All initial appointments to the working group shall 103
be made not later than thirty days after the effective date of this section. 104
If such appointments are not made not later than thirty days after the 105
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effective date of this section, the Commissioner of Social Services may 106
designate individuals with the required qualifications for the applicable 107
appointment to serve on the working group until such appointments are 108
made. 109
(d) The working group may consult with stakeholders, including, but 110
not limited to, current enrollees in Access Health Connecticut, enrollees 111
in the state's medical assistance programs, health care providers, health 112
insurance issuers, health care advocates, researchers, actuaries and 113
nonprofit health care service providers. 114
(e) Members appointed pursuant to subdivisions (11) and (12) of 115
subsection (b) of this section shall serve at the pleasure of the appointing 116
authority and shall continue to serve until their successors are 117
appointed. Any vacancy shall be filled by the appointing authority. 118
(f) A majority of the membership of the working group shall 119
constitute a quorum for the transaction of any business and any decision 120
shall be by a majority vote of those present at a meeting. The 121
chairpersons may establish such committees, subcommittees or other 122
entities as they deem necessary to further the purposes of the working 123
group. The working group may adopt rules of procedure. 124
(g) The members of the working group shall serve without 125
compensation, but shall, within the limits of available funds and subject 126
to the approval of the working group's chairpersons, be reimbursed for 127
expenses necessarily incurred in the performance of their duties. 128
(h) Not later than December 1, 2026, the working group shall submit 129
a report to the joint standing committees of the General Assembly 130
having cognizance of matters relating to appropriations and the budgets 131
of state agencies, human services and insurance and real estate 132
concerning the group's recommendations for the design and 133
implementation of the basic health program. Such report shall contain a 134
description of the program, including, but not limited to, operations and 135
funding for the program. For purposes of this section, "Access Health 136
Connecticut" means the Internet web site maintained by the Connecticut 137
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Health Insurance Exchange, established pursuant to section 38a-1081 of 138
the general statutes, through which enrollees and prospective enrollees 139
may obtain standardized comparative information on and enroll in 140
qualified health plans under the Affordable Care Act. 141
Sec. 4. ( Effective July 1, 2026 ) Prior to implementation of the basic 142
health program, the Commissioner of Social Services shall hold at least 143
one public hearing for the program and a series of stakeholder 144
engagement meetings with potential stakeholders, including, but not 145
limited to: (1) Representatives of hospitals, health centers, other health 146
care providers, HUSKY Health plan enrollees and Access Health 147
Connecticut enrollees, (2) members of the joint standing committees of 148
the General Assembly having cognizance of matters relating to 149
appropriations and the budgets of state agencies, human services, 150
public health and insurance and real estate, and (3) other persons with 151
health equity and health coverage policy expertise. 152
This act shall take effect as follows and shall amend the following
sections:

Section 1 July 1, 2026 New section
Sec. 2 July 1, 2026 New section
Sec. 3 from passage New section
Sec. 4 July 1, 2026 New section

Statement of Legislative Commissioners:
In Section 1(f), the last sentence was redrafted for clarity; in Section 3,
"cochairperson" and "cochairpersons" were changed to "chairperson"
and "chairpersons" for clarity and consistency; in Section 3(b)(8), "along
with the Secretary of the Office of Po licy and Management, or the
secretary's designee," was added for clarity, and in Section 3(h), the
definition of "Access Health Connecticut" was added for clarity.

HS Joint Favorable Subst. -LCO

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The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of
the General Assembly, solely for purposes of information, summarization and explanation and do not
represent the intent of the General Assembly or either chamber thereof for any purpose. In general,
fiscal impacts are based upon a variety of informational sources, including the analyst’s professional
knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final
products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note

State Impact:
Agency Affected Fund-Effect FY 27 $ FY 28 $
Social Services, Dept. GF - Cost See Below See Below
Note: GF=General Fund
Municipal Impact: None
Explanation
Section 1 results in a cost to the Department of Social Services (DSS)
associated with establishing a basic health program. DSS will incur
initial contracting costs of at least $750,000 to develop and submit the
required waiver as well as costs for additional staff and resources to
perform an actuarial analysis, procure a managed care organization,
and set up other potentially necessary operational mechanisms to
implement the program. The costs to implement the program are
dependent on how the program is ultimately structured.
Section 2 establishes the "basic health program account", which is a
separate, non-lapsing account. Moneys in the account shall be expended
by DSS solely for the purposes of operating a basic health program
referenced in section 1.
Section 3, which does not result in a fiscal impact, requires DSS to
establish a working group to oversee the design of the basic health
program and submit on the working group's recommendations for a
basic health program no later than December 1, 2026.
Section 4, which does not result in a fiscal impact, requires DSS to
hold at least one public hearing and a series of stakeholder engagement
meetings prior to implementation of the basic health program.
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The Out Years
The annualized ongoing fiscal impact identified above would
continue into the future subject the creation of a basic health program
and funding available for such purposes.

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OLR Bill Analysis
sHB 5559

AN ACT CONCERNING A BASIC HEALTH PROGRAM.

SUMMARY
Starting October 1, 2026, this bill requires the Department of Social
Services (DSS) commissioner to seek any necessary federal approval to
establish a Basic Health Program (BHP), an optional program under the
federal Affordable Care Act (ACA)(see BACKGROUND). The
commissioner must do this in consultation with the Office of Policy and
Management (OPM) and based on the recommendations of the working
group the bill establishes to oversee the program’s design.
Under the bill, the BHP provides subsidized health insurance to
eligible low-income residents who would otherwise qualify to purchase
coverage through the state’s health insurance exchange (Access Health
CT). Generally, the program must provide the same benefits, cost-
sharing limits, and other consumer safeguards that apply to Connecticut
Medical Assistance Program (CMAP, Medicaid, and the State Health
Insurance Program for Children) recipients.
The federal government largely subsidizes the BHP’s costs, and the
bill establishes a separate, nonlapsing BHP account for these subsidies.
The account must contain any moneys required by law to be deposited
into it and DSS must use the funds only to operate the program.
Additionally, the bill requires the DSS commissioner to:
1. forward any federal applications to approve or make changes to
the BHP to the Appropriations and Human Services committees
and the bill’s BHP working group at least 30 days before
submitting them;
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2. hold at least one public hearing on the BHP and a series of
stakeholder engagement meetings before implementing the
program; and
3. report to the legislature on the program’s operations, activities,
and finances every six months starting by January 1, 2027,
through January 1, 2030, and annually after that.
EFFECTIVE DATE: July 1, 2026, except the working group provision
takes effect upon passage.
BASIC HEALTH PROGRAM
Program Administration and Benefits
The bill requires the DSS commissioner to coordinate the BHP’s
administration and benefits and take all necessary actions to maximize
federal funding. To the extent the ACA allows, it requires the BHP to
provide the same benefits, cost-sharing limits, and other consumer
safeguards that apply to CMAP recipients, unless the commissioner
determines that:
1. doing so will cost more than the federal subsidies available to the
state to pay for the BHP or
2. changes in federal law or regulations (or their administration)
will affect BHP funding, eligibility requirements, or
administration.
If the commissioner makes this determination, she may, in
consultation with OPM, develop a plan to respond to these changes.
Under the bill, if the federal subsidies the state gets to pay for the BHP
are more than the cost of care that would otherwise be provided to
eligible people, the commissioner must use the extra funds to reduce the
premiums and cost sharing for these people or give them additional
benefits.
Eligibility Requirements
Under the bill, the BHP provides subsidized health insurance to
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Connecticut residents (1) with household incomes between 133% and
200% of the federal poverty level, (2) under age 65, (3) ineligible for
CMAP, and (4) otherwise eligible to purchase a qualified health plan
through Access Health CT.
Public Hearing
Before implementing the BHP, the bill requires the DSS commissioner
to hold at least one public hearing on the program, as well as a series of
stakeholder engagement meetings with potential stakeholders,
including (1) representatives of certain health care providers (for
example, hospitals and health centers), CMAP, and Access Health CT
enrollees; (2) Appropriations, Human Services, Insurance and Real
Estate, and Public Health committee members; and (3) other experts in
health equity and health coverage policy.
Report
Under the bill, the DSS commissioner must report to the
Appropriations, Human Services, and Insurance and Real Estate
committees on the BHP’s operations, activities, and finances, as well as
any supporting documentation or data for the immediately preceding
reporting period. The commissioner must submit the reports (1) every
six months, starting by January 1, 2027, through January 1, 2030, and (2)
annually after that.
BHP WORKING GROUP
Duties
The bill requires the DSS commissioner to establish a working group
to oversee the BHP’s design. In doing its work, the group may consult
with stakeholders, including current Access Health CT and CMAP
enrollees, health care providers, health insurers, health care advocates,
researchers, actuaries, and nonprofit health care providers.
Membership
Under the bill, the working group membership includes the
following state officials or their designees:
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1. Connecticut Healthcare Advocate,
2. social services and insurance commissioners,
3. Commission on Racial Equity in Public Health executive director,
4. State Comptroller,
5. OPM secretary,
6. six top legislative leaders, and
7. Insurance and Real Estate Committee House and Senate
chairpersons.
Additionally, the Human Services Committee House and Senate
chairpersons serve as the working group’s chairpersons along with the
OPM secretary or his designee.
The working group also includes the following additional members:
1. Access Health CT chief executive officer;
2. three health insurance experts from nonprofit and academic
communities, with demonstrated knowledge of health plan
design and actuarial practices, appointed by the working group
chairpersons; and
3. any other members the chairpersons deem necessary.
Under the bill, appointed members may be legislators. Appointing
authorities must make their initial appointments within 30 days after
the bill’s passage and fill any vacancies. If appointments are not made
within that time, the DSS commissioner may designate qualified people
to serve on the working groups until the appointments are made.
Appointed members serve at the pleasure of their appointing
authority and must continue to serve until their successors are
appointed.
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Members serve without compensation but may be reimbursed for
necessary expenses incurred when performing their duties if (1) funds
are available and (2) the working group chairpersons approve it.
Meetings
Under the bill, a majority of the working group’s members constitute
a quorum for transacting business. Any decision must be made by a
majority vote of members present at the meeting, except that the
chairpersons may establish committees, subcommittees, or other
necessary entities to do the working group’s work. The working group
may also adopt procedural rules.
Report
The bill requires the working group, by December 1, 2026, to report
to the Appropriations, Human Services, and Insurance and Real Estate
committees on (1) its recommendations for the BHP’s design and
implementation and (2) a description of the program, including its
funding and operations.
BACKGROUND
BHP
The ACA allows states to establish BHPs for people (1) ineligible for
Medicaid, (2) under age 65, (3) with household income between 133%
and 200% of the FPL (people with incomes under 133% of the FPL
qualify for Medicaid), and (4) ineligible for minimal essential health care
coverage (for example, State Children's Health Insurance Program
(HUSKY B in Connecticut)) or who cannot afford their employer's
coverage.
The federal law imposes cost-sharing limits and requires that state
BHPs provide benefits at least as rich as those in the state’s “essential
health benefits package” available to someone purchasing insurance
through its health insurance exchange.
States that operate a BHP are eligible for federal subsidies equaling
95% of the premium tax credits and cost-sharing reductions that the
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federal government would have spent if BHP enrollees had received
their assistance when enrolling in an exchange health plan.
The law requires states to establish funds into which the federal
subsidies are deposited and that can be used only to reduce BHP
enrollees’ premiums and cost sharing or to give them additional benefits
(42 U.S.C. § 18051).
COMMITTEE ACTION
Human Services Committee
Joint Favorable
Yea 16 Nay 7 (03/19/2026)