Centers for Medicare and Medicaid Services (CMS) recently released guidance to help
states align Alternative Benefit Plans (ABPs) under Medicaid programs with the
Essential Health Benefit (EHB) requirements. Prior federal Medicaid law (Deficit Reduction Act of 2005, §1937 of the Social Security
has allowed states to design Medicaid
benefit packages under their state plans. The Affordable Care Act (ACA)
made changes to §1937 that become effective on January 1, 2014, which are:
intends for the provisions of the recent EHB proposed rule, released on November 20, generally to apply to
Medicaid. However, modifications will be provided in future rulemaking
that will apply when furnishing EHB services to Medicaid beneficiaries. CMS' State Medicaid Director letter says, "[s]ection 1937
coverage options are a starting point for states to establish their [ABPs], and
the process for ensuring coverage of and, as necessary, adding EHBs will mirror
steps taken by issuers in the individual and small group markets … "
states to develop a benefit plan that meets the ACA provisions, CMS proposes
that (1) states initially choose a coverage option from the choices in §1937
and (2) then determine whether the §1937 option is one of the options that is
available for defining EHBs in the individual and small group market (there is
overlap between these options).
future regulations, CMS intends to propose the following provisions, among
States that wish to establish a new §1937 ABP or to modify an existing ABP substantially are required to
publish public notice for public comment from stakeholders prior to submitting
their State Plan Amendment to CMS.