Medicaid Benchmark Coverage
The design of benchmark coverage for the expansion population will affect utilization of services and access to care. States may wish to consider the unique needs of those newly eligible for Medicaid when designing these plans.
*Milestone details:
*Full name: Establish benchmark coverage for the Medicaid expansion population consistent with federal laws and regulations.
*Relevance to the ACA:
The ACA provides that newly eligible Medicaid beneficiaries receive “benchmark or benchmark-equivalent coverage.” Benchmark coverage is defined as one of the following: the standard Blue Cross/Blue Shield PPO plan offered to federal employees, the state employee health benefit plan, or the largest commercial health coverage plan offered by an HMO in the state. Benchmark-equivalent coverage must include, at a minimum: inpatient and outpatient hospital services, physicians’ surgical and medical services, laboratory and x-ray services, prescription drugs, mental health treatment, well-baby and well-child care, and preventive services designated by the Secretary. (§2001)
less
comment, ask a question or post a document
Login or Register to participate in this discussion or post a document
Kansas
If that state has closed enrollment, then they won't be enrolled if they were eligible but didn't take advantage of it before?
District of Columbia
Hi Ellen- Thanks for asking. Prior to the ACA, states could not cover non-disabled adults without dependent children through Medicaid unless they obtained a waiver. A few states that expanded coverage to low-income adults prior to the ACA, had to close enrollment to new applicants. These individuals may be eligible for Medicaid if their state decides to expand to 138% FPL. (You can find more information on eligibility levels for children and non-disabled adults here: http://www.kff.org/medicaid/7993.cfm).
Other individuals could purchase coverage through a health insurance exchange. Citizens and legal residents in families with incomes between 100% and 400% FPL are eligible for a tax credit to reduce the cost of coverage. In states without expanded Medicaid coverage, individuals with incomes less than 100% of poverty will not be eligible for exchange subsidies, while those with incomes at or above poverty will be.
Kansas
I have yet to find an answer for this. If a currently eligible signs up for Medicaid in Oct., will they receive the benefits of the Medicaid Expansion or of the current Medicaid policies? And will the Federal share be 100% or the current level of reimbursement for Medicaid? Thanks
District of Columbia
Hi Ellen: Starting on January 1, 2014, states will have to provide an Alternative Benefit Plan (ABP) benefit package to two types of groups: (1) the new adult group in states that choose to expand eligibility to adults at or below 133 percent FPL and (2) current optional or waiver adult groups that receive a benchmark or benchmark-equivalent benefit under Section 1937 of the Social Security Act. If a person is currently eligible and does not fall into (2), then he/she will receive current Medicaid benefits. Each state’s Alternative Benefit Plan must include non-emergency transportation; Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services; family planning services; and the 10 Essential Health Benefits (EHBs). The Alternative Benefit Plan must also comply with the requirements of the Mental Health Parity and Addiction Equity Act. You can find more information about ABPs in this resource from Manatt Health Solutions: http://www.statereforum.org/sites/default/files/medicaid_benchmark_benef....
If a state chooses to expand eligibility to adults at or below 133 percent FPL, the state will receive the 100 percent FMAP for these individuals from 2014 to 2016. This enhanced FMAP will gradually decrease to 90 percent in 2020. However, if the person is currently eligible for Medicaid, the state would receive the regular Medicaid FMAP for that particular state.
District of Columbia
The Washington Health Care Authority released Medicaid expansion strawman proposals for the development of the Alternative Benefit Plan, which would be based on the standard Medicaid benefit package, and a proposed overview of potential Medicaid cost sharing regulations. They are accepting comments until March 1, 2013.
http://www.statereforum.org/sites/default/files/alternative_benefit_plan...
District of Columbia
A new report, prepared by Health Management Associates, examines four options for New York’s Medicaid benchmark plan selection. The four benefit options analyzed in this report are: 1) Medicaid 2) Family Health Plus, 3) multiple benchmark plans and 4) commercial insurance.
District of Columbia
Milliman prepared a report for the State of Iowa, Department of Human Services, Iowa Medicaid Enterprise (IME) to provide information and education about decisions, considerations, and options available to the State in terms of the Medicaid Benchmark Plan.
District of Columbia
The Medicaid Advisory Committee made a presentation recommending the Oregon Health Plan Plus as the state's Medicaid Benchmark Plan. The Committee feels it will minimize disruption for individuals who move among different benefit packages within the OHP.
District of Columbia
Manatt Health Solutions released a memorandum reviewing the information CMCS provided in their letter to State Medicaid Directors on Medicaid benchmark benefit coverage options for the newly eligible Medicaid adult group.
District of Columbia
CMS wrote a letter to the State Medicaid Directors on November 20, 2012 to provide guidance on the use Medicaid benchmark coverage options (Alternative Benefit Plans) for the new eligibility group for low-income adults; the relationship between Alternative Benefit Plans and Essential Health Benefits (EHBs); and the relationship of section 1937 with other Title XIX provisions.
District of Columbia
See interesting thoughts from Stan Dorn at the Urban Institute about Medicaid Benchmark Coverage here:
http://www.statereforum.org/discussions/essential-health-benefits
District of Columbia
This presentation from Leavitt Partners recommends the selection of Idaho’s Basic Benchmark Plan as the state's Medicaid benchmark package if it pursues the Medicaid expansion. The Basic Benchmark Plan is the HHS Secretary‐approved Medicaid benefit package provided to healthy children and working age adults currently. The Idaho Medicaid Expansion Workgroup is scheduled to provide its analysis and recommendations to the governor by November 1, 2012.
District of Columbia
This powerpoint gives an overview of the benefit design of public insurance programs in D.C. and how this will be impacted by ACA.
View the presentation here:
http://www.statereforum.org/sites/default/files/34990015-benefit-design-...
District of Columbia
This report includes sections that highlight key components of ACA and then discusses areas for federal guidance and possible state policy changes.
http://www.statereforum.org/sites/default/files/caimplementingnationalhe...