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CMS Releases Guidance on Medicaid Benchmark Options

Wednesday, November 21, 2012

On November 20, 2012, the Centers for Medicare and Medicaid Services (CMS) released a State Medicaid Director Letter which provides guidance to states on benchmark benefit options for the new eligibility group of low-income adults created by the Affordable Care Act (ACA). States have several options to choose from when selecting the benefit they will offer the Medicaid expansion population, but whatever benefit is ultimately offered to the newly eligible population, it must include the ten essential health benefits (EHBs), one of which is behavioral health treatment in compliance with the Mental Health Parity and Addiction Equity Act. CMS also indicated that states may "select more than one benchmark plan to define EHBs for different segments of the Medicaid population."

States must submit a State Plan Amendment describing the benchmark plan they intend to offer the newly eligible low-income adult group by the first calendar quarter of 2013. Regulations implementing the various provisions of the ACA related to Medicaid benchmark plans are forthcoming.   

Learn more about the Medicaid expansion and enrollment pathway considerations for vulnerable populations.