Filed Under:Health Insurance, Individual Health

PPACA: 19 states missed essential benefits deadline

PPACA toolbox. (AP Photo/Jacquelyn Martin)
PPACA toolbox. (AP Photo/Jacquelyn Martin)

The U.S. Department of Health and Human Services (HHS) has received essential health benefits (EHB) package notices from 31 states and the District of Columbia, according to Chris Cantrell of State Refor(u)m.

The State Refor(u)m is an arm of the National Academy for State Health Policy.

HHS is still waiting for EHB notices from 19 states, Cantrell reported.

Cantrell found that 10 of the states that have not recommended EHB benchmark plans have taken steps such as analyzing existing state benefit mandates and assessing benchmark plan options.

Nine states — Florida, Iowa, Indiana, New Jersey, New Mexico, Ohio, Oklahoma, Wisconsin and West Virginia — have taken no formal steps toward recommending benchmark plans.

Similarly, 9 states of identified themselves as not picking an EHB benchmark because they are awaiting federal guidance. Those states are Alabama, Florida, Indiana, New Jersey, Ohio, Oklahoma, Pennsylvania, Wisconsin and West Virginia.

Some states with Republican governors who have opposed the Patient Protection and Affordable Care Act of 2010 (PPACA) have announced EHB benchmarks. Some of the states with Republican governors and EHB benchmarks include Arizona, Kansas and Virginia.

PPACA calls for state and federal agencies to set up exchanges, or Web-based health insurance supermarkets, by 2014, and for the plans sold through the exchanges to offer packages of benefits based on the EHB benchmarks, to ensure that consumers get comprehensive coverage, help them with apples-to-apples comparisons, and discourage insurers from watering down benefits.  

HHS officials are letting states express their EHB preferences. HHS officials recommended earlier this year that states try to get EHB benchmarks to HHS by Sept. 30.

HHS has said that it will choose a benchmark plan for states that fail to recommend their own benchmark preferences.

HHS has asked states to come up with EHB benchmark plans based more on small group coverage than on "Cadillac plans," but it also has noted that PPACA requires the EHB to include some pediatric dental and vision benefits and possibly some "habilitative services."

Habilitative services are services similar to rehabilitation services provided for individuals who are born with limits on their ability to function, such as children with autism and other developmental disorders.

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Nichole Morford

Nichole Morford
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