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)