Updating the Essential Health Benefit Benchmark Plan: An Unexpected Path to Fill Coverage Gaps?

By Sabrina Corlette and Joel Ario*

On August 28, 2020, the U.S. Department of Health & Human Services (HHS) approved new essential health benefit (EHB) benchmark plans for Michigan, New Mexico, and Oregon, bringing to five (with Illinois and South Dakota) the number of states that have revised their benchmarks in recent years. Although many stakeholders were concerned that new rules for EHB benchmark selection adopted in the 2019 Notice of Benefit and Payment Parameters (NBPP) would result in less generous benefits, these five states have modestly enhanced their benefit packages to address perceived gaps in coverage.

Moreover, these states have added benefits without triggering the Affordable Care Act (ACA) provision requiring states to defray any additional premium costs associated with new mandated benefits. That requirement would have applied if these states had added new benefits through legislative or regulatory action “separate from an EHB-benchmark plan selection process.”

In a new post for the Robert Wood Johnson Foundation’s State Health & Value Strategies program, CHIR’s Sabrina Corlette and Manatt Health’s Joel Ario examine how five states took advantage of an effective safe harbor for expanding benefits, albeit under the limited parameters of the 2019 NBPP. You can read the full blog post here.

*Joel Ario is a Managing Director at Manatt Health and a technical assistance provider to the State Health & Value Strategies program.

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