Designing Medicaid Benchmark Benefits for New Adult Beneficiaries

By: Deborah Bachrach
– BNA’s Health Care Policy Report

On Dec. 16, 2011, the Center for Consumer Information and Insurance Oversight (CCIIO) within the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) released a bulletin providing guidance with respect to: (i) new state flexibility to design the ‘‘essential health benefits’’ (EHBs) that plans in the individual and small group markets sold inside and outside of Health Insurance Exchanges must cover; and, (ii) reference plans to which a state may link its EHBs. Regardless of a state’s choice of the EHB reference plan, the state’s EHB package must include the 10 areas of care listed in the Patient Protection and Affordable Care Act (ACA) and may include state-mandated benefits at least in 2014 and 2015. HHS intends to revisit this approach in 2016. On Feb. 17, HHS issued a Frequently Asked Questions (FAQs) document providing additional guidance on its approach to defining EHBs.

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