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CMS Publishes Final Rule on Essential Health Benefits & MAGI-Eligibility

Monday, February 25, 2013

On February 22, 2013, the Center for Medicare and Medicaid (CMS) issued a final rule on Essential Health Benefits, formalizing guidelines for core benefits that all insurance plans must offer beginning in 2014 as part of the Affordable Care Act (ACA).  The Essential Health Benefits identify ten categories of services, and expands services critical to people with mental health and substance abuse service needs.  The full published rule is available from the Federal Register

CMS also announced a two phase process for states to document their verification plans for Medicaid and CHIP eligibility.  The first phase requires states to submit a plan for how they will verify eligibility for Medicaid & CHIP based on Modified Adjusted Gross Income (MAGI) Eligibility.  States must submit their plans by March 31, 2013.  A template for state plans is available from Collaborative Application Lifecycle Tool (CALT) and instructions for completing the plan are available from  Phase 2 will require states to submit verification plans for people who are MAGI-excepted populations (people who are aged, blind or disabled).  CMS will issue further guidance on Phase 2 plans, including a template, at a later date.

For more information on the ACA and the Medicaid Expansion, visit TAC's resource page on health reform.