State of the States: California and Colorado Identify EHB Benchmark Plans

On Thursday, August 30, California passed legislation establishing the Kaiser Small Group HMO 30 plan as the state’s essential health benefits benchmark plan. Beyond identifying the state’s benchmark plan, the legislation appears to include a number of important consumer protections by, for example, prohibiting plans from making substitutions for essential health benefits even when substitutions are actuarially equivalent (which the U.S. Department of Health and Human Services suggested it would allow) in most cases. The legislation also adopts the same requirements regardless of whether a plan is sold inside or outside of the California Health Benefit Exchange. The legislation will now go before Governor Jerry Brown for his approval no later than September 30, 2012.

On Friday, August 31, Colorado’s Health Benefit Exchange, Department of Regulatory Agencies and the Office of the Governor issued a joint draft recommendation for the state’s essential health benefits benchmark plan. The three organizations recommended the Kaiser Ded/CO HMO 1200D plan, the state’s largest small group plan, as the state’s benchmark on the basis that it includes benefits in all ten federally required benefit categories and “meets the requirement to reflect benefits in a typical employer plan.” The three organizations also discussed how they came to their recommendation, describing the objectives that policymakers considered and the public meetings and comment periods that were held. In supplementing the plan, Colorado recommended the Child Health Plan Plus for pediatric dental benefits and noted that the benefit-specific recommendations are contingent on the details of federal guidance still to be released. The three organizations are requesting public comments on the draft through September 10, 2012.

California and Colorado become  the seventh and eighth states—along with Connecticut, Oregon, Utah, Virginia, Vermont, and Washington—to publically recommend a benchmark plan. Of these states, they join Oregon, Virginia, Vermont, and Washington in endorsing a small group plan as the benchmark. Once its legislation is signed, California will become the second state to have officially identified its benchmark plan, joining Washington, which enacted its own legislation in March.

Stay tuned to CHIRblog to keep you updated on state action on essential health benefits as it happens and be sure to look for our upcoming issue brief (funded by the Commonwealth Fund) on state decisions in all 50 states and the District of Columbia as well as keep up with our other posts tracking state action in our “State of the States” blog series!

The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.