U.S. Department of Health and Human Services Releases Essential Health Benefits Bulletin to the States

In a surprise move last Friday, HHS released a bulletin announcing its intention to let states determine the scope of essential health benefits to be established under the Affordable Care Act.  The  Essential Health Benefits Package (EHB) forms the basis for insurance coverage offered through the state-based “exchanges,” when they become operational in 2014.  The EHB will determine health care coverage for millions of Americans – and will potentially influence the structure of health plans in the private markets as well.  NASW issued initial comments for how the EHB package should be designed and NASW chapters in Texas, Massachusetts and Georgia participated in regional EHB hearings.

Friday’s announcement allows significant variations in benefits from state to state, much like the current differences in state Medicaid programs and the Children’s Health Insurance Program.    Each state would choose one of the following health insurance plans as a benchmark:

  • One of the three largest small-group plans in the state.
  • One of the three largest health plans for state employees.
  • One of the three largest national health insurance options for federal employees.
  • The largest health maintenance organization operating in the state’s commercial insurance market.

Details are available at: http://cciio.cms.gov/resources/files/Files2/12162011/essential_health_benefits_bulletin.pdf.

NASW  would have preferred a strong national standard for the EHB package, without a great deal of state-to-state variability. We will be submitting additional comments on the proposed EHB plan in January.

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