As individuals’ income and circumstances change they will move among coverage programs. States must balance the advantages of consistent coverage across programs against the practical challenges and cost implications of doing so.

*Milestone details:

*Full name: Decide in which instances, if any, to pursue continuity in benefit design across Medicaid, CHIP, the basic health program, if adopted, and private insurance markets inside and outside the Exchange.

*Relevance to the ACA:

The ACA, along with previous federal and state law, establishes minimum benefit requirements for Medicaid, CHIP, the basic health program and qualified health plans sold in Exchanges. These minimums vary by program. Although, the ACA does not require that states align benefit designs among these programs, states may wish to do so in order to prevent disruptions in service as individuals move among the programs. However, aligning benefits presents practical challenges associated with harmonizing coverage rules across programs. It may also have cost implications—increasing costs if additional benefits are added to some programs, while possibly decreasing costs if care continuity yields better health outcomes.

§1001 – Requires a uniform explanation of benefits and coverage offered by all group and individual health plans.

§2301, §2502, §4107 – Adds new Medicaid benefit mandates.

§10203 – Requires benefits and cost-sharing in qualified health plans for children to be comparable to those offered under CHIP.

§1331 – Requires that a state basic health program provide at least those essential benefits required of qualified health plans.

§1302 – Establishes “essential benefits” for qualified health plans.